Registration form Women's retreat Susanne Amoraal

First name

Last name

Date of birth

Address

Postal code

Recidence

Country

Phone number

Company Name
(only needed if you'd like to receive a business invoice)

Company Registration Number
(only needed for business payments)

Invoice Address
(only needed if different from your home address)

The reason I want to participate is:

I have the following dietary requirements (we eat vegetarian):

Name and phone number of the person we can call in case of emergency:

Options for your stay:
Stay in a shared 4-person bedroom (no extra charge)Stay in a shared 2-person bedroom (additional price €100)Private use of a 2-person bedroom (additional cost €250)

Ultimatly, please fill out the next questions:

I declare that I have no mental or psychic illnessI agree that my email address and telephone number will be shared with the other participants of the retreat I am registering forI agree that my data will be stored for billing and information purposesI agree to the terms and conditions and I am aware of the cancellation policy

Room for additional comment:

I declare that I have completed the above information truthfully.

Registration form Women's Retreat with Susanne Amoraal