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Croatia Spiritual Retreat 2015 Form (for Each Attendee)
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Croatia Spiritual Retreat 2015 with HH Bhakti Charu Swami
First Name
*
Please enter your name as it appears on your passport
Your answer
Last Name
*
Please enter your name as it appears on your passport
Your answer
Initiated Name (If applicable)
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Gender
*
Choose
Male
Female
Date of Birth
*
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DD
/
YYYY
Primary Contact No. (Mobile or Landline)
*
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Primary Email ID
*
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Home Address
*
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City
*
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Post Code
*
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Nationality
*
Your answer
Passport No.
*
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Passport Expiry Date
*
MM
/
DD
/
YYYY
Place of Issue of Passport
*
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Emergency Contact Name
*
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Relationship with Emergency Contact
*
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Emergency Contact No.
*
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Any special Dietary Requirements
*
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Any Allergies / Health Conditions / Medications etc.,
*
This information will be strictly confidential and be shared only with the Retreat Health Representative
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Retreat Charges (PER PERSON) - EUROPEAN Group
EUROPEAN Group means, you make your own way to the Iz Island. Prices are per adult & are all inclusive of accommodation and prasadam
Other:
Name of Payee
*
This helps us to group your family members forms together under same group
Your answer
Name(s) of People in your Group
If you are a group of family or friends, please Name them so we can group them while allocating
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Sharing Room With (If)
Preferred Sharing Names (from your group)
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Questions / Queries
Email on '
retreats@krishnatemple.com
' or contact Mr. Pradeep Kabra on 00 44 (0)7708 620256
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