Registration for Fractured in France at Chateau Dumas

Saturday 13-20 August 2022

Name

First Name

Last Name

Full address

Your personal mobile/cell

In case we need to contact you during the Retreat

Passport no

Required by French authorities

Emergency contact name and telephone number

Dietary requirements

Vegetarian (no meat or fish)

Pescatarian (no meat)

Vegan (no meat, fish or dairy)

Gluten-free

Lactose-free

None

Please use this space to tell us anything else you think we should know about your diet

Medical conditions

Please use this space to let us know about any medical conditions or physical challenges you think we should know about

You must be fully vaccinated against Covid-19 to join this retreat. Please confirm that all your vaccinations will be up to date by the start of the retreat.

Yes

Non-participating partners - please use this section to tell us about the person who is accompanying you

Please let us know their name, whether they have any dietary requirements or medical conditions and confirm their vaccination status

Further information

Please use this space to add anything else you would like us to know

Thank you very much for completing the form.

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