Sample Page Online Booking Form Name(Required) First Last Address(Required) Street Address Address Line 2 City County / State / Region Post Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email(Required) Phone(Required)Emergency Contact Number(Required)Do you have a disability or medical condition I need to be made aware of?DO you have any allergies or dietary requirements I need to be aware of?Course Title(Required)Select a CourseNatural DyeingWildlife GardeningOrganic GardeningForest GardeningWorkshop 1 Herbal infused oilsWorkshop 2 Making balmsEco printingCourse start Date MM slash DD slash YYYY FeeCourse TitleSelect a CourseNatural DyeingWildlife GardeningOrganic GardeningForest GardeningCourse start Date MM slash DD slash YYYY FeeCourse TitleSelect a CourseNatural DyeingWildlife GardeningOrganic GardeningForest GardeningCourse start Date MM slash DD slash YYYY FeeAdd Another Course? Yes No Voucher CodeConsent(Required) I agree to the Booking Terms and ConditionsBooking Terms and conditions Places are allocated on a first come first served basis on receipt of 20% non-refundable deposit. On receipt of payment, an invoice will be sent to you. Please reference the invoice number when making further payments towards the outstanding balance. Full payment must be settled 14 days prior to the course commencing. Cancellation must be received in writing 14 days prior to the course commencing. I reserve the right to cancel a course if minimum attendee numbers are not met. Moneys will be refunded in full in this instance and if the course is cancelled due to unforeseen circumstances. If a session cannot go ahead, every effort will be made to reschedule said session. Any student unable to attend the rescheduled session will be refunded in part.How Did you hear about us?(Required) Word of mouth Google search Facebook Prefer not to say Other Please remit payment to Maritime Costs Consultants Ltd. Account No. 03181383. Sort Code. 09-01-50 By signing this form, I confirm: • The information I have provided is correct • I have read and agreed to Gingerfields booking terms and conditionsSignature(Required)CAPTCHA
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