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Gaia Visions Retreat Online Booking Form

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Fields marked with an asterisk (*) are obligatory.

Participant 1 Details

Name:*
Address of Participant 1: *
Phone No of Participant 1: *
E-mail of Participant 1:
Contact in Case of Emergency:

 

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Participant 2 Details

Name:
Address of Participant 2:
Phone No of Participant 2:
E-mail of Participant 2:
Contact in Case of Emergency:

 

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Dates  
Holiday Dates: from:
Holiday Dates: to:
Holiday Option/s Select YES in the box
A week at Gaia only:

£415
An Additional Week at Gaia:
£275
A Week at Gaia Plus 1:1 Life coaching & Healing: £649
Reiki I: £95
Reiki II: £95
Reiki III:
£350
Sailing Trip:
£32
Mountain Trip:
£27
Additional Massage or Reiki Treatment ( Full Body ):
£30
Additional Massage or Reiki Treatment ( Part Body):
£24
Total Holiday Price:

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I am making full payment /deposit by cheque/credit card/bank transfer. Holiday deposit is £100. The balance is due 8 weeks before departure.
 
You will be given details of payment when you click submit.
Flight Details  
Flight No for Arrival to Zakynthos:
Name of Airline:
Time and Date of Arrival:
Time and Date of Departure:
Name of Airport Departing from:

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Health Issues *
 Please, detail medical conditions, injuries, special dietary requirements, medication, medical or psychiatric supervision or any major physical or emotional illness. Please give details and if appropriate confirm in writing you are fit to travel and enclose a doctor's certificate.
Insurance and Health
 Non-disclosure of relevant information can invalidate your insurance and cancel our contractual obligation to you. Disclosure helps us to look after you and your needs. All information is confidential.

Please click the box:

 I understand the consequences of non-disclosure of relevant information. Select YES in the box.

 

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Insurance Declaration
A: I have not yet arranged insurance but I will inform you as soon as I do Select YES in the box:
B: I have taken insurance cover with:

Policy No:
Insurance Declaration
 It is a condition of booking that you are insured. Please select YES in the box:   

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Booking Declaration

I have read and agree to accept the Gaia Visions conditions of booking and cancellation, which form part of this contract. I acknowledge that full payment is due 8 weeks before departure date.

Please view our terms and conditions booking.

Select YES in the box to confirm: *

 
Your name:

 

Click Submit to send the form

Click Reset to cancel.

 

 

 

 

 

 

 

  
 


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