Agreement Philippines

Please be kind enough to fill the form below so we can serve you better.

Your Group Trip to the Philippines is Booked

Please note that all fields followed by an asterisk must be filled in.

First Name*

Last Name*

Gender*

Year of birth*

Your weight in kgs

Your height in cms

Email address*

City

Country*

Cell Phone Number including country code*

Are you on one of those?*

	WhatsApp
	Messenger
	Skype
	Google hangout / talk
	None

If sharing a room, full name of your partner

Partner's weight in kgs

Partner's height in kgs

First name & Last name of any other travelers in your party

Name(s), phone number and email address to contact in case of emergency (preferably more than 1 person)*

Day & Time of arrival*

Return Flight Date & Time*

Are you bringing a wheelchair?*

If at least one of you intends to join my lectures (you must speak good English) please state their first name, and explain their health problems. Repeat the above for each person who will attend my lectures. This will be used by Patrick to help you.

Confirm your acceptance of our Agreement at www.therapies.com/agreement.html on behalf of ALL travelers*

	I/we have read it and I/We agree to its terms
	I/we have not read it but agree to it anyway

How did you hear about our trips?*

Please enter the word that you see below.