Name:

Address:

Country: Postal/Zip:

Phone Daytime : Phone Evening:

Cell: Fax:

Email:

Room Preference:

2 Bedroom Suite: Sofa Bed

B&B Room: Double Queen

Hostel Room: Double Twin

Number of Adults: 1 2 3 4 5 Number of Children (infant-16 years) : 0 1 2 3 4

We would like to book B&B Queen B&B Double 2 bedroom suite Hostel Room: Double Hostel Room: Twin

We are travelling with our pet(s). Yes No Number and Type:

Special Needs/Questions:

I would like more information on health & healing sessions and Total Body Energy Coaching.

Date of Arrival:

Date of Departure:

Preferred Method of Contact: Phone Email

Dietary Restrictions:

IF SENDING BY FAX, PLEASE COMPLETE THE FOLLOWING:

Card Type: Mastercard    Visa   Amex

 
Card # Expiry date

Signed____________________________________________

All cheques to be payable to: Clare McDuff
Mail to:
185 Horel Road West,
Saltspring Island, BC,  V8K 2A4,
Canada

We look forward to your visit.