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)