Artemisia Registration Form

We are delighted that you wish to join one of our trips. Please read the following very carefully before proceeding: This registration form is legally binding between AHA Courses Ltd and the person responsible for paying the fees and must be filled out by the feepayer. Once you have submitted this form, you will be sent the means of payment for the deposit. In order for your place to be totally secure, we must receive payment of the deposit within 7 working days of the date of submission.

* indicates obligatory field

Select trip

Number of attendees

Attendee 1 (Feepayer)

First Name (as it appears on passport)

Last Name (as it appears on passport)

Preferred name (if different from above)

Maiden name

Date of Birth (Select year, month then day)

Tel Code

Mobile Telephone Number

Confirm Email

Passport

Passport Number

Passport Issue Date

Passport Expiry Date

Place of Issue (e.g. UKPA)

Nationality

Country of Birth

I am aware that I am responsible for my own visa

Yes

Not applicable

Address

Your Country

Address (Line 1)

Address (Line 2)

Address (Line 3)

Town

Your County/State/Region

Your Postcode / Zip Code

Insurance details

I have travel insurance

Yes

Name of Insurers

Tel Code

Their emergency services contact number

Medical and dietary information

Do you have any medical conditions?

Yes

Please provide further details

What medication do you take?

Do you have any dietary requirements?

As we organise lunches in advance this information is important to us.

Yes

Dietary requirements

Additional information

Emergency contact name and telephone number for family member or friend in the UK

Would you like a double room for single use?

Please note single occupancy supplement.

Yes

How did you hear about us?

Please enter their name

TRAVEL INSURANCE: I understand that by submitting this form I undertake to organise comprehensive travel insurance for the duration of the trip and I will ensure the policy covers all repatriation and medical expenses. PASSPORTS & VISAS: I understand that by submitting this form I undertake to ensure I have a valid passport for travel over the dates shown above and will organise any necessary visas for travel to Italy. YOUR DETAILS: I understand that AHA Courses will securely hold my details on their database, will not pass them onto any third parties and will use them exclusively in connection with all AHA courses and events. THE DEPOSIT: I will send a deposit of £600 per person, within 7 days of submission of this form. (On receipt of this form we will email you details of how to make a deposit payment. Payments to be made by bank transfer or cheque; please note that we cannot accept credit card payments. Your place will only be secured on receipt of the deposit payment).

Terms & Conditions

I have read the Terms & Conditions taking special notice of the cancellation procedure.

You will get a "thank you" page once this form is successfully submitted and then a welcome email. If you do not receive these, the application has not been processed, so please email us, [email protected], so we know you want to join us.