Please fill in and/or tick (* needed) First name* Last name* Birthday Street* Zip code / City* E-Mail* Phone* Check in Date (D|M|Y)* Check out Date (D|M|Y)* Arrival (GOI old airport) Arrival (GOI old airport) Arrival (GOI airport) 50 € Arrival (GOX new airport) 30 € Departure (GOI old airport) Departure (GOI old airport) Departure (GOI airport) 50 € Departure (GOX new airport) 30 € Please pick me up Please pick me up Please pick me up dd.mm.yyyy & hh.mm (arrival india time) Requested room* Requested room* Luxury Cottage with A/C Cross Ventilation Room Wooden Huts Double Bedroom House w. A/C Number of additional person DBH(required)* Number of additional person DBH(required)* 0 1 2 3 Adult (first person required)* Adult (first person required)* additional person 2nd and more person choice (required)* 2nd and more person choice (required)* 2nd and more person (no treatment) 2nd and more person (with treatment) Payment* Payment* Creditcard Paypal on arrival Discount Discount Travel agency Member NG e.V. Coupon Recommended by (Name needed) Note or requested room number (limit to 150 characters) SEND THE REQUEST Your request has only been sent when the form disappears.