24—28 MAI 2017 / LYON, FRANCE

PARENTAL AUTHORIZATION LIABILITY RELEASE

I, the undersigned (name & first name of the legal representative) : ............................................................................................................................. Residing to (complete adress) : ....................................................................................................................................................................................................... Phone number I can be reached all day long to : .................................................................................................................................................................. The minor's legal representative (name & first name) : ........................................................................................................................................................ Born on (date & place of birth) : ....................................................................................................................................................................................................... Residing to (complete adress) : ....................................................................................................................................................................................................... Hereby authorises Mr or Mrs (specify name & first name of the major guardian) : ................................................................................................. to accompany and be responsible for the minor for the whole duration of the event (specify the minor's name & first name) : . ........................................................................................................................................................................................................................................................................... in order to attend the NS Days event of (specify the day(s) concerned) : ..................................................................................................................

Thank you for joining to this filled and signed release a photocopy of the following identity cards : — legal representative — major guardian — concerned minor and send all documents to [email protected] before may 24, 2017 Date and place of signature : .................................................................................................................................................................................... Legal guardian's signature (preceeded by the words «Read and approved»)