Balingup Bliss Retreat-Booking Form

Balingup Bliss Retreat - Booking Form Short Stays or Retreats
Please use this form to request accommodation or telephone 9764 1467 if you prefer.

Please complete all required fields. Required fields are marked *

First name:*
Surname:*
Address:*
Suburb:*
Post Code:*
Your day time telephone:*	No spaces please
Your email:*
Arrival date:*
Departure date:*
3 & 5 Day Retreat Dates :	eg: Feb9th
Any Questions :

Please type in security code

Details ANZ BSB No 016 305
Account No 5217 90829
Name Tanya K Avard
Internet transfer details (Please enter your name in the ID area when making your transaction so I can identify your payment