BOOKING FORM

Booking form to be completed and returned to:

Retreats Beyond Dover

Flat 19 G, Peabody Buildings

Wild Street, Covent Garden

London WC2B 4BQ

Tel: 020 7379 7273

I wish to book a place for:

Retreat	Date From	Date To
The Martyrs Of Otranto Retreat House, Sta.Cesarea Terme, Province Of Lecce, Puglia, Italy	09 September 2015	19 September 2015

PASSENGER DETAILS

Title	Surname	Christian Name	Date of Birth

PLEASE NOTE: YOUR NAME SHOWN ABOVE MUST BE EXACTLY THE SAME AS THAT SHOWN ON YOUR PASSPORT

Address: .............................................................................................................................................

..............................................................................................................................................

Home Number: ..................................................................................................................................

Work Number: ...................................................................................................................................

Email: ..................................................................................................................................................

Please book accommodation in (Single / Double ) Room

I confirm that I shall travel with my own travel insurance, arranged by:

(Please indicate Your insurer)

...............................................................................................................................................................

A deposit of £100 per person must be remitted with this booking form. Deposits will only be refunded in the event of the retreat being cancelled by RBD and not in any other circumstance.

I understand and accept that vegetarian meals will not be available at any time during my retreat.

I have read the attached terms and conditions of booking.

Signed ................................................... Date ....................................................