HANDI-HOME FORM
HADRA TRANCE FESTIVAL 2022

APPLICANT'S INFORMATION :

E-mail Address*

Surname of the person with a disability*

Name of the person with a disability*

Telephone number of the person with a disability*

ID card of the person with a disability*

Proof of disability (disability card, medical certificate, etc.)*

Nature of the handicap (motor, psychic, sensory, difficult standing,...)*

Specific device(s):*
NoneManual wheelchairElectric wheelchairCrutchesWalkerOther

If you have chosen "Other", please specify:

INFORMATION FOR THE ACCOMPANYING INVITATION :

If you are eligible for the invitation for your companion, an email will be sent to you with the invitation. Please note that the invitation will be in the name of the person with a disability and not in the name of the accompanying person.

In order to gain access, the person with a disability must present a valid ticket and his or her identity card, in the presence of his or her companion, at the festival ticket office.

The accompanying person is subject to the same terms and conditions as those of the ticket purchased by the PRM person

Name and surname of the accompanying person*

Telephone number of the accompanying person*

Would you like a place in the PMR campsite ?
ouinon

License plate of the vehicle which will be able to benefit from a place in the PMR parking:

Special needs

Please add any additional information to improve your reception