Retreat Booking Form

Please complete and sign by ticking the box at the end of this form. A copy will be emailed to you for your records.

Retreat Information

Retreat Name, Location & Date

Retreat Guest

A separate form is required for each retreat guest

Name

Email Address

Home Telephone Number

Mobile Telephone Number

Postal Address

Date of Birth

Passport Number

Passport Issue Place

Passport Issue Date

Passport Expiry Date

Nationality

Sex (M/F)

Emergency Contact Details

Emergency Contact Name

Emergency Contact Relationship to you

Emergency Contact Telephone Number

Medical Information

Doctor's Name

Doctor's Telephone Number

Doctor's Address

Known Medical Conditions

Known Allergies

Blood Type

Current Medications

Dietary Requirements

Including allergies and intolerancies

Retreat Travel Insurance

It is a requirement of the retreat that you have travel insurance that covers cancellation of the retreat, any medical costs, injury, loss of property, etc.

Insurance Company

Insurance Company Telephone Number

Policy Number

Payment

I confirm that I will pay any outstanding balance via BACS no later than 8 weeks prior to retreat start date

Payment should be made to:
Irinis Kitchen Limited
Lloyds Bank
Account No. 50864660
Sort Code 30-96-26
Bic/Swift: LOYDGB21446

Retreat guest declaration

by ticking here you register to participate in the retreat and declare that you have read and understood the terms and conditions

At the time of signing, I hereby confirm that I have read and understood the Terms and Conditions, including the cancelation policy of this retreat published on www.irinicooks.com. I accept the price quoted and I understand that I am solely responsible for ensuring that my passport is valid for at least six months beyond the date of my return and for obtaining all necessary visas.

Signature

Please enter your full name to confirm