Retraite pour les Jeunes Adultes: Pleine conscience, Mouvement et Convivialité

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1 Welcome

2 Price

3 Participant Info

Birth Date *
Gender
Do you wish to share a room with a friend or partner?	Yes No
What is the name of your friend or partner	Please make sure both partners book their places at the same time (or as quickly as possible)to avoid the place being taken by another participant
Country of Residence *
Emergency Contact Info *	Please include name, phone number and e-mail address
Special Diet	Gluten Free Dairy Free Cannot eat eggs Vegan All meals at the Moulin are Vegetarian. Please indicate if any of the above options applies to you.
Do you have a Severe Medical Alllergy? *	Yes No
Quelle somme pouvez vous payer ? (en plus des 50 euros de frais d'inscription) *	Afin que cette retraite soit accessible à tous, nous proposons un tarif flexible, compris entre 400€ et 700€, en fonction de votre situation financière. Nous précision que la tranche basse couvre les frais de base. Ce tarif comprend, les ateliers, le logement, et les repas. Si ces prix restent inaccessibles et que vous souhaitez participer, n'hésitez pas à nous contacter par email à narayan.aylward@icloud.com.
Please give details	Please also indicate if this is a medical allergy or a mild/severe intolerance

4 Additional information

5 Payment

	By submitting payment, you authorise Moulin de Chaves to send instructions to the financial institution that issued your card to take payments from your card account in accordance with the terms of Moulin de Chaves's agreement with you.

Please note that your booking will only be confirmed once payment is received.