GIF/Teens Fiction and Film December 15, 2012
GIFTED in FRANCE

FICTION AND FILM AND THEIR INTERPLAY
with Author Sheila Kohler
DATE: December 15, 2012
TIME: 10:30-12h30
AGES: 13-16+
LOCATION: 75015, Metro Volontaires
RSVP: Please fill out this online form to secure your spot.
PARTICIPATION FEE: 10 euros, GiF Members have priority
     please mail check in advance to Gifted in France, 39 ave de Versailles 75016
     (include the participants name, last name, age, phone number and email.)
Deadline: December 5

For questions, please email giftedinfrance@gmail.com

PLEASE FILL OUT A SEPARATE FORM FOR EACH PARTICIPANT.
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Parent's last name
Parent's First Name
Participant's Last Name *
Participant's First Name *
GiF member? *
If not, would you like to join?
Cell phone number in case of emergency? *
Home phone number?
Primary email address? *
Participation Fee
Participant's Age? *
Participant's Birthday?
Follow this format: Day/Month/Year
Participant's Class/Grade? *
Questions, comments?
How did you hear about this event?
Authorization *
 I agree that the above information is correct and attest that I have an insurance policy (responsabilité civile vie privée) covering my child’s participation in such activities.  I authorize Gifted in France to take pictures and/or video during these events for use on its blog and/or publications.. I understand that if my child becomes repeatedly disruptive that he or she may be excluded from future events or admitted at the discretion of the host and organizers.
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