Refuge de la présence incarnée : Retraite de Méditation et de Yoga

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1 Welcome

3 People in your group

Guest 1		First Name* Last Name* Email* Gender*
Guest 1		First Name* Last Name* Email* Gender*

After completing this form, emails will be sent to everyone in your group to complete their information.

4 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 *
Phone *	Please include country code
Understanding of English *
Compréhension du français *
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 The Moulin offers a vegetarian menu that is largely gluten-free, dairy-free, and egg-free. All dishes are clearly labelled when they contain these ingredients. We are only able to accommodate special dietary requirements in the case of medical conditions, including allergies or severe intolerances. If this applies to you, please tick yes and give details below
Please give details	Please also indicate if this is a medical allergy or a mild/severe intolerance
Moulin Guidelines *	I accept the Moulin Guidelines. Please read the Moulin Guidelines

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