Contact Details

Full Name

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Home Address Including Post Code

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Home Tel No including area code

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Mobile Number

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Email Address

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Passport Details

Only fill this section in if Cueropo Fiestas Retreats are booking your flights:

Name as it appears on passport

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Passport Number

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Place of Birth

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Date of Birth

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Date of Issue

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Passport Expiry Date

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If booking your own flights

Date and Time of Arrival

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Date and Time of Departure

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Treatments

Treatment one
FacialBack MassageReflexologyIndian Head MassageLeg MassageReiki
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Treatment two
FacialBack MassageReflexologyIndian Head MassageLeg MassageReiki
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Treatment three
FacialBack MassageReflexologyIndian Head MassageLeg MassageReiki
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Additional Treatments
FacialBack MassageReflexologyIndian Head MassageLeg MassageReiki
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Dietary Requirements

Please state any special dietary requirements you may have

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Health Problems

Please state any health problems you may have and list any medication you are taking

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Retreat Experience

Please indicate from the list below what you are looking for by attending the retreat:
RelaxationWeight LossIncreased FitnessUnwindMake New FriendsControl EatingBe PamperedChill OutAlone TimeOther
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if you answered 'other' to the above, please explain

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Room Request

Please state the number of people in your group
12345678910
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Please state the names of the people in your group

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To help us allocate rooms please state the relationship between your group, for example:

Friend/Partner

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Please note each member of your group must fill in a booking form

Payment information will need to be sent over the phone, please call: 0121 742 1788

I wish to book. Please choose the option you wish to book:

Weekend Retreat
£657.00 with flights£557.00 without flights
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Mid Week Retreat
£757.00 with flights£657.00 without flights
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Complete Retreat
£957.00 with flights£857.00 without flights
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Additional Costs
£50.00 Single room£50.00 En-suitNone
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Please note that if the -£50.00 early bird booking fee applies (on all bookings made before 31st December 2010), this will be deducted when we process payment.

Finders Fee: £100.00 for every friend you refer who books the complete package.