Ayurveda Bali

From:	To:
First/Lastname:
Street:
Location/Postal Code:
Home Phone:	Work Phone:
eMail:	Fax:
Age:	Occupation:
Experience with body- or energy work:
Deposit: 250 Euro	at:
Kreissparkasse Gmund (Germany): BLZ 711 525 70	Bank Account: 8591760 BIC code: BYLADEM1MIB IBAN: DE27 7115 2570 0008 5917 60
Bank Transfer □	Check □
Bank account (for possible refund):
Account#:	Bank:
Airline, Flight number:
Arrival date and time:
I would like to be fetched from the airport (starting from 15€ per person):
My registration is binding. I have read and accept the Ayurveda Registration and Participation Conditions.
Date:	Signature:

www.ayurvedalife.de