It's Time To Go!

You're just one step away from your retreat place.

Just complete the form below and we will confirm everything by return

Here's to the brand new you!

 

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CONFIRMATION

  • Personal Details
  • Payment Details
  • Medical History
  • Declaration

YOUR DETAILS

Let's start with your personal details

NAME

email address

mobile number

House number & Postcode

Which retreat are you attending (date)

CARD DETAILS

So that we can process your payments, we need your details and authorisation. Please complete all sections below

CARD NUMBER (no spaces)

EXPIRY DATE

CARD SECURITY NUMBER

Is this your card?

if no, please confirm who's card it is and you have their permission to charge to it

I give you my authorisation to charge my card in relation to payments relating to this retreat

MEDICAL / FOOD / TRAVEL

Are you taking any medication? If so, please list

Does any of the medication require needle disposal?

Please detail any physical restrictions or reasons you may not be able to participate in all elements of the retreat

FOOD

Are there any foods you do not eat through religious or personal preference?

Do you have an intolerance or allergy to any food type (please list or state 'none')

TRAVEL

We book your flights for you. Please complete the information below

Which is your airport of choice

PASSPORT NUMBER

FULL NAME AS IN PASSPORT

YOUR NATIONALITY

EXPIRY DATE

COUNTRY OF ISSUE

TRAVEL INSURANCE PROVIDER

FLIGHT PREFERENCES

BAGGAGE PREFERENCE

WOULD YOU LIKE TO BOOK EXTRA LEGROOM SEATING (CHARGE APPLIES) (IF AVAILABLE)

SELECT AIRLINE SEAT (CHARGES APPLY)

Do you require special assistance at the airport?

Treatment Packages

Pease select your chosen treatment package option below

CONFIRMATION

IN THE HIGHLY UNLIKELY EVENT WE NEED TO CONTACT SOMEONE ON YOUR BEHALF, WHO SHOULD THIS BE?

WHAT IS THEIR RELATIONSHIP TO YOU?

WHAT IS THEIR CONTACT NUMBER?

DECLARATION

IF THERE IS ANY OTHER INFORMATION YOU WISH TO ADD THAT WE SHOULD KNOW ABOUT, PLEASE ADD IT HERE

I AGREE TO THE BOOKING TERMS & CONDITIONS & CONFIRM ALL INFORMATION I HAVE PROVIDED IS CORRECT

PLEASE TYPE YOUR FULL NAME TO CONSTITUTE YOUR ELECTRONIC SIGNATURE OF THIS FORM