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Enrollment Form

Preferred Date:*
Number of Participants:*


Salutation:	Other:
Last Name:*
First Name:
E-mail Address:*
Nationality:*

Address:*

City:*
State:*
Zip:*
Country:*
Accommodation:*
Phone:
Cel Phone:
Fax:

I authorize you to charge the credit card specified hereunder according to the Terms & Conditions outlined below.

Type of Card:*	Amex Master Visa I'll fax it Today
Issuing Bank:**
Card Number:**
Expiry Date:**	Month: Year:
Name on Card:**

* marks required field.
** marks required field unless you fax your credit card details.

IMPORTANT

Please complete and return this Enrollment Form as soon as you can since these cooking classes are often fully booked well in advance.
If you choose the fax option for submitting your credit card details, please don't forget to send all details (name of card, issuing bank, card number, expire date, exact spelling of card holder's name) by fax to +62-361 701-577 at the same time as you send us your Enrollment Form. We can only start processing your request after having received your credit card details.
We try to confirm all enrollments within two working days, or, if the dates of your choice should not be available, you'll receive alternative suggestions.
If your enrollment can be confirmed, full pre-payment will be charged to guarantee your enrollment.
Enrollment fees charged are not refundable if you do not attend some or all of the classes confirmed for whatever reason.

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Baliguide.com / Bali.com Ltd
D&B D-U-N-S No. 66-389-8141
Reservation & Service Center
Tel. +62-361 703-060 (12 lines)
Fax +62-361 701-577
E-mail: info@baliguide.com

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