Please Complete This Form and E-Mail It to Nurjamil on

Booking form –for SHO Retreat 2-6th May 2013

Please complete this form and e-mail it to NurJamil on .

(E-mailed forms are preferred. However forms may also be printed off, completed and sent to SHO Dre Isaf, Ystrad Meurig, Ceredigion, SY25 6AA if e-mailing is difficult.)

A. Your contact details

Name: ______

Address: ______

______

______

Postcode: ______

Phone: ______

email: ______

B. Your meditation and healing background

Please give a few words about your experience with meditation and your experience or training in healing. (Previous experience is not a requirement for the retreat.)

______

C. Health

So that we can support you to the best of our ability, please tell us if there is anything you would like us to know about your physical, emotional or mental health.

As all bedrooms are above the Ground Floor, please let us know if you have difficulties with stairs.

______

D. Payment

Concessions are available with prior application to NurJamil 01974 831091

or

Pay by making a bank transfer to HSBC The Sufi Healing Order General A/C no 71265024 bank sort code 40.04.37, or send a cheque made payable to Sufi Healing Order to SHO, Wendy Hunt, Northend Farm - The Dairy, Venn Lane, North Chideock, Bridport, Dorset DT6 6JY.

Accommodation is in shared rooms.

Please tick one of the following -

Retreat, full board and lodging in shared room £ 285 ______

Retreat, full board and camping £ 220 ______

Deposit, full payment at the start of retreat £ 100 ______

All food is delicious and vegetarian.

If you have simple (eg wheat-free, dairy-free) special dietary needs please also tick-

Special diet supplement £8 ______payable on booking

Please contact us if you have complex dietary needs. We will do what we can to help, though these may cost more.

For help with this form, please phone 01974 831091