Casa Sangam - registration form

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CASA SANGAM

Registration form

Name of retreat*:

Dates of retreat*:

YOUR PERSONAL DETAILS

Country*:

City:

Genre*:
Male-Female

First name*:

Surname*:

Age*:

Email address*:

Mobile number:

Profession:

Organisation:

YOUR ARRIVAL INFORMATION

Arrival date at CS*:

Will you be coming directly to CS from the airport or train station?:
YESNO

IF YES

Flight / Train number:

Flight / Train arrival time:

From what airport or train station will you be coming?*:

IF NO

What is your estimated arrival time at CS (time on 24:00 clock)?:

YOUR DEPARTURE INFORMATION

Departure date from CS*:

Will you be going directly to the airport / train station from CS?*:
YES-NO

IF YES

From what airport or train station will you be leaving?:

Flight / Train departure time*:

IF NO

What is your estimated departure time from CS (time on 24:00 clock)?:

TO HELP US WITH YOUR STAY

Comments & special needs (sensor or mobility disability...):

If you do have a special diet please indicate which one (i.e.: no sugar, no milk, no wheat, allergy to... etc):

Have you been to a residential retreat at CS before?:
YESNO

Name of the person to contact in case of emergency whilst you are at CS*:

Telephone Number of the person to contact in case of emergency whilst you are at CS*:

If you know of 1 or 2 people who would be happy to share a room whit please let us know their name:

Verification*:

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