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Reservation Form for Kerala, 2011To be completed by each person individually and sent by email, fax, or post
Please indicate the appropriate items:
_____Kerala Retreat from 29 January - 10 February, 2011 _____Extended stay until _____________ _____Kerala, Agra, Varanasi and Delhi 4-18 February
_____I wish to come to Ananda Assisi and travel with the group to Kerala. _____I wish to join the group flight from Rome ___________ or Milan __________
_____Standard Cottage, double occupancy _____Standard Cottage, single occupancy
_____Garden Cottage, double occupancy _____Garden Cottage, single occupancy
_____Special Cottage, double occupancy _____Special Cottage, single occupancy
I wish to share a room with: __________________________________________
Please note: If you do not have a roommate, we will try to connect you with another single pilgrim. However, we cannot guarantee finding a suitable roommate for you. If a roommate cannot be found, you will need to pay for single occupancy.
Name, exactly as it appears on your passport:
Date and place of birth:
Passport number:
Date and place where your passport was issued:
Expiration date of your passport (needs to be valid until middle of November, 2011):
Address:
Telephone, mobile phone, email:
Have you been to India before? If so, when and where?
Do you already practice meditation and yoga, and if yes, what kind?
Thank you!
For further information (including travel contract policy etc), please contact Arjuna at (0039) 393-9650534 or Bhaktan: india@ananda.it.
INFORMATION ACCORDING TO LAW 196/2003, ART. 13According to Article 13 of Law 196/2003, we are required to inform you that:
Formula for acquisition of consensus for the treatment of sensitive dataPlace ............................. Date ................................ Surname ............................................ Name ................................................................. Having read the information provided by the Association according to article 13 of law 196/2003, and being aware in particular that some of the information requested is regarded as “sensitive” data in Article 4, paragraph 1(d), and Article 26 of Law 196/2003, i.e. “information regarding: ethnic and racial origins; religious or philosophical beliefs; political opinions; affiliation to political parties, trade unions or religious, philosophical , political or trade-union organizations; personal data concerning health and sexual life,” I give my consent to use the data that are necessary for carrying out the operations above indicated. (legible) signature .......................................................................
Technical organization:
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For information and reservations:
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