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First name*

Last name*

E-Mail*

Birthday

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Zip code / City*

Phone*

Landline (Home)

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)

Room Pick* Room Pick* Wooden Huts Cross Ventilation Room Luxury Cottage with A/C Double Bedroom House w. A/C

Wooden Huts Wooden Huts Wooden Huts 01 Wooden Huts 02 Wooden Huts 03 Wooden Huts 04

Cross Ventilation Room Cross Ventilation Room Cross Ventilation Room 05 Cross Ventilation Room 06 Cross Ventilation Room 07 Cross Ventilation Room 08

Luxury Cottage Luxury Cottage Luxury Cottage 09 Luxury Cottage 10 Luxury Cottage 11 Luxury Cottage 12 Luxury Cottage 13 Luxury Cottage 14 Luxury Cottage 15

Double Bedroom House w. A/C Double Bedroom House w. A/C Double Bedroom House w. A/C 20 Double Bedroom House w. A/C 21 Double Bedroom House w. A/C 22 Double Bedroom House w. A/C 23

Number of additional person DBH(required)* Number of additional person DBH(required)* 0 1 Person 2 Person 3 Person

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)