Wild at Heart Men's Camp 9-11 August 2019Retha Venter Kamp 13-15 Sept 2019   Complete the full booking form for the “From Trauma to Glory” weekend seminar 13-15 Sep 2019, to enable us to make your stay as comfortable as possible. Please complete all the fields below: (mandatory) 1. Name & Surname:  _________________________________________________________ 2. Contact number:   __________________________________________________________ 3. Email:  ___________________________________________________________________ 4. Residential area or city/town:  ________________________________________________ 5. I would like to share a room with: (person’s name and surname) ___________________ 6. Medical dietary requirements:  ________________________________________________ Our menu consists of good quality home cooked meals and we can unfortunately not make provision for individual preferences. Should you however have a medical condition with regards to your dietary requirements, please provide us with a short summary to enable us to make provision for you in the menu (if possible) and to determine the possible different costing. Vegetarian requirements will also be charged extra  7. Payment structure: Please note, no booking is confirmed unless full payment has been received in our bank account. Only once final payment has been received will you be provided with a reference number, room allocation and list of items to bring along  Option 1: Deposit: R600 when booking is submitted 2 x Instalments of R350 each: end July & end Aug	Option 2: Once off R1300 when booking is submitted Date that all payments must be finalised: Monday 2 Sep 2019       7.1 Payment options: (tick one box)       Option 1: (Deposit of R600 and       2 x R350 instalments end July & end Aug)	             Option 2: (Once off R1300)       7.2 Date that payment will be made: __________________________________________       7.3 Please Upload your proof of payment to submit with your booking: BANK DETAILS NAME:                  GALGEBERG OORD CC BANK:                   ABSA BRANCH:              SANTYGER SANTYGER (632005) BIC CODE:             ABSAZAJJ ACCOUNT NO:    4071697165 Reference:           Your Name, Surname & Camp Name 8. Indemnity form completed and submitted: ______________________________________ 9. Any other questions or information you need to provide us with: (e.g. elderly that cannot sleep on the top bunker bed, walking impairments)