I would like to take part in the following workshop(s) / retreat(s).

Title of event	Date	Total Fee

Name
Address
Town / City
Postcode
Tel / Mob
Email
Emergency contact (next of kin/family or friend)
Emergency contact number:

Payment details:

A non-refundable deposit (£100.00 for courses below £400: £200 for courses over £400) secures your place on the course, unless otherwise stated in the course details. The outstanding balance is due four weeks prior to the course start date, either by cheque or bank transfer (BACS).

How do you intend to pay?

Cheque (made payable to Anam Cara):
Electronic bank transfer (for reference please use your name and workshop code*):
Cash:
* If paying by bank transfer, when we receive your form we will send you our bank account details together with the workshop code to use in your reference.
If BACS, please enter date of transfer:
If BACS, please enter amount:

For workshops/retreats starting in the morning:
I will arrive 3-6pm the day before (£35 for B&B or £40 includes a simple self-service supper)	I will arrive the morning of the event

For workshops/retreats starting in the evening (arrival 3-6pm):
Please indicate your estimated time of arrival:
How did you hear about us?

For Data Protection we now need to ask permission to keep your details on our database.

May we keep your information on our database?
If you would like to receive a copy of our quarterly newsletter and annual brochure of events please tick here.
(We never pass details on to third parties.)

Dietary Requirements

All meals provided are vegetarian. Due to the additional food costs and preparation required for restricted diets, we are only able to cater for this when due to medical conditions or food allergies. Therefore, please only tick the appropriate dietary requirement box/es on the booking form if this applies.

Vegan
Dairy free
Wheat free
Gluten free
Sugar free

Other (Please specify)

Medical Requirements

Due to the varied nature and content of our workshops/retreats it is essential that you let us know about any current medical conditions, medications or mental health issues that may affect your participation.
Please specify below

If there are no relevant medical issues then please tick below:

I have no medical/physical/mental health conditions that may affect my participation.

All information will be treated in confidence.

We will email you a confirmation letter with additional information after we have processed your booking form. In the meantime, if you have any further queries please don't hesitate to contact us.

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