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?
Which June RESET retreat package would you like to book?
Name Of Guest 2 (Guest 2, please complete a new form with your personal details.)

First NameLast Name
HEALTH AND NUTRITION INFORMATION
Do you have any nutritional preferences or requirements? Please select all that apply or provide specific details by selecting ‘Other’.

Other
Are there any foods you will not eat?
Do you have any medical conditions?
Please state any medical conditions below.
Are you taking any medications?
Please state any medications below.
Do you have any current or pre-existing injuries that need to be considered for your retreat?
Please state any injuries below.
How did you hear about Solas Retreat?

Other
Securing Your Booking - Please select how you would like to make your deposit payment.

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.

$800.00 AUD Quantity

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

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: