Solas Reset Retreat Booking Form

Solas Reset Retreat Booking Form

JUNE 19-21, COMO The Treasury, Perth WA.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Date Of Birth

DayMonthYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
EMERGENCY CONTACT DETAILS
Name*

First NameLast Name
Relationship to you
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address - PLEASE COMPLETE IF DIFFERENT TO YOUR OWN

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Which RESET retreat date would you like to book?
Premium Indulgence - your own bedroom and ensuite bathroom in a Heritage Room. $2,600ppCouples Package - for two people. Your own bedroom and ensuite bathroom in a Heritage Room. $3,800 per couple.Friends Package - come with a friend. Your own twin share bedroom and ensuite bathroom in a Heritage Room. $1,900 per person.
Name Of Guest 2 (Guest 2, please complete a new form with your personal details.)

First NameLast Name
HEALTH AND NUTRITION INFORMATION
NONEGluten FreeFODMAPVegetarianVeganDairy freeVeganCoeliacEgg freeNut freeOther
Are there any foods you will not eat?
YesNo
Please state any medical conditions below.
YesNo
Please state any medications below.
YesNo
Please state any injuries below.
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Online payment via StripeBank transfer direct from your bank account

Online Payment via Stripe

Solas Retreat Deposit

Non-refundable deposit only to secure your booking at any of our Solas Retreat experiences. Your deposit will be deducted from the total investment of your retreat.

$800.00AUD Quantity

Total

$0.00AUD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Bank Transfer direct from your bank account

Payment of your $800.00 non-refundable deposit can be made via your online banking. Please use the following details to make your payment and please send your remittance to sharon@solasretreats.com.au

Account Name: Uplifting Fitness

BSB: 016460

Account Number: 384423773
Guest Participation Agreement
Should be Empty: