Give Yourself a Break Retreat Registrasie Vorm Give Yourself a Break Retreat Registrasie Vorm: Baie dankie vir jou betaling en deelname aan ‘Give Yourself a Break Retreat.’Sodoende jy maksimale waarde uit die naweek kan kry, vul asb die onderstaande vorm in. Give Yourself a Break Retreat - Registrasie VormΔBetalings Verwysings Nommer ('Order ID' op kwitansie) NaamVanE-PosSelfoon nommerAdressAdres Lyn 1Adres Lyn 2StadKodeProvinsie- Kies -GautengKwaZulu NatalVrystaatNoord-WesNoord-KaapWes-KaapOos-KaapMpumalangaLimpopoAllergieë of dieet vereistes (Neem asb in ag dat daar 'n moontlike ekstra koste sal wees aan spyseniering afhangende van die tipe allergie of dieet vereiste).Naasbestaande (naam en van)VerwantskapNaasbestaande selfoon nommerIndemnity: I hereby irrevocably indemnify and hold harmless: 5th AVENUE GOOSEBERRY GUEST HOUSE, its owners, agents and employees against all and any actions, suits, proceedings, claims, demands, costs and expenses of whatsoever nature incurred from, any direct, indirect or consequential loss or damages I may suffer, and which may be taken or made against them or be incurred or become payable by them, arising out of my stay at the guest house. I hereby certify and represent that I am over 18 years of age and have read the foregoing and fully understand the meaning and the effect thereof.BoodskapStuur Vorm