Reservation

Marked fields (*) are obligatory!
Your information will be treated as strictly confidential and only used for the purpose of your booking.

Surname *

First name *

Exact Address *

Phone : *

Fax

E-mail *

Number of adults

Number of children (under age 10)

Please Indicate participant's type of disability

physical
visual
audio
Other
None

Equipment in use

Manual Wheelchair
Electrical Wheelchair
Scooter
Crutches
Other

Possible medication, if it's important

Medical requirements we would like to know about (i.e. heart problems, blood pressure etc)

Special Dietary Requirements

Allergies

Required type of accommodations

**
***
****
*****

No. of single rooms

No. of double rooms

No. of triple rooms

Required facilities in accomodation

Personal Carer Service

Yes
No

Possibly equipment, which would You like rent by us.

Preferred Guide Language

English
German
French
Russian
Inny

Special interest

Sightseeing
Classical Music
Folk Music
Film or Theatre
Shopping
Cruising
Other

Comments & requests

I accept Terms & Conditions