Way of Nature Journey for Women
June 4th-7th 2021
Name *
Email *
Mobile Phone Number: *
Name of Next of Kin and Telephone Number: *
Your Organization (if any)
Where Did You Hear About Us?
How are you planning to arrive and depart to the programme? *
Dietary restrictions *
Do you suffer from any of the following conditions? *
Do you suffer from epilepsy? *
Do you suffer from any other condition requiring that we should be aware of including previous injuries, medical treatment and medication? *
Are you allergic or sensitive to any medication (e.g. Penicillin), insect bites or food? *
Are you taking any form of medication on a regular basis? (If so please ensure that you have adequate supplies of medication for your entire visit) *
To the best of your knowledge, have you been in contact with any contagious or infectious diseases, or suffered any recent condition that may become infectious or contagious? *
Please provide any additional appropriate information concerning your health: *
In order to participate in a Way of Nature Programme it's essential that you have read through and agreed with our Terms and Conditions that you can view here: http://bit.ly/2g9r7Zu. Please take some time to read through it.
By clicking 'Yes' below you confirm that you have read through and understood the Terms and Conditions agreement between yourself and Way of Nature UK Ltd. *
To confirm your place we ask for payment of the full amount. Please use your last name as your reference when paying into the bank account below and drop us a quick note when you have made the transfer: Bank name: Co-operative bank Account name: Way of Nature Ltd Sort code: 089299 Account: 69683358 BIC: CPBKGB22 IBAN: GB27CPBK08929969683358
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