WELL-KEPT SECRETS

ENROLLMENT FORM
ONE FORM FOR EACH PERSON ONLY
     
Full name of person enrolling :
Sharing with (if applicable) :
ROOM TYPE REQUIRED (All room are non-smoking rooms) :
Preferred Tour Date (see below) :
Your home Address :
City : State/Prov : Postal Code/Zip :
Country :
Home Phone : Work phone :
Fax : Mobile :
E-mail :
Food or other allergies: :
Special dietary requirements :
Emergency contact Name :
Tel No : Email :
     
CULINARY ALCHEMY OF THE ARCHIPELAGO DATES
2013, 16th - 24th November    
2014, 20th - 28thJanuary 14th – 22nd June  
  15th - 23rd February  13th – 21st September  
  5th - 13th April 11th – 19th October  
  10th - 18th May 15th – 23rd November  
       
TOTAL COST FOR 2 PERSONS SHARING A ROOM:   US$ 6,210.00
SINGLE OCCUPANCY:   on request



INCLUSIONS: All transfers, events, activities, cooking classes, accommodation with full breakfast and all meals as specified in the programme every day. Not included are airfares to/from Denpasar, Bali, any beverages & other personal costs such as laundry, telephone calls or gratuitie.

ADDITIONAL NIGHTS & OTHER  ITINERARIES:
If you would like to reserve additional nights at either of our resorts before or after the programme or if you would like us to suggest personal interest itineraries to other parts of Bali or Java, please contact: gusti@well-keptsecrets.info specifying any tentative dates or preferences you may have.

 

YOUR FLIGHT DETAILS:
Please provide us with the following so that we can arrange airport transfers both ways for you:

ARRIVE DENPASAR, BALI   DEPART DENPASAR, BALI
Flight no :   Flight no :
Airline :   Airline :
Last place of departure :   Departure destination :
Arrival Date to Bali :   Departure Date :
Arrival Time in Bali :   Departure Time :
             

PASSPORTS & VISAS:
Please read the information below very carefully!
The entry fee for a Visa on Arrival into Indonesia is US$ 25.00 per person. If your passport is due to expire within six months from the date of entry into Indonesia, you will have to apply for a new passport. Your passport must also have at least 6 entry-free pages.
No refund of the programme cost will be made by Well-kept secrets, nor will any expense incurred by a participant due to forgotten, lost, invalid or expired travel documents before or during the programme.
     
PASSPORT DETAILS – for a couple/husband & wife
Passport no :
Full Name EXACTLY as in Passport :
Issuing Country :
Date of Issue :
Date of Expiry :
Nationality :
Date of Birth :
Occupation :
Gender :
     
2ND Person/couple    
Passport no :
Full Name EXACTLY as in Passport :
Issuing Country :
Date of Issue :
Date of Expiry :
Nationality :
Date of Birth :
Occupation :
Gender :

INSURANCE: We advise you to take out a cancellation insurance to prevent incurring costs in case you have to cancel the programme at the last minute. Also please review your illness and accident insurance regarding cover outside your country.

CANCELLATION POLICY: Cancellations must be received in writing.
1) The 10% deposit is not re-fundable
2) A fee of 20% is to be paid if a cancellation is made less than eight weeks before the programme is due to begin.
3) The total amount for the programme will be charged if cancellations are made less than four weeks before the programme is due to commence.

PROGRAMME CANCELLATION & MINIMUM NUMBER OF PARTICIPANTS:Well-kept Secrets reserves the right to cancel the programme in the event that enrollment does not reach the budgeted minimum number of participants. In this case, those who have already enrolled will be refunded for any payments made. If the programme has to be cancelled due to acts or occurrences beyond our control then the refund cost will be affected accordingly.

LIMITATIONS OF LIABILITY: Well-kept Secrets neither accepts nor assumes liability or responsibility of any kind or nature for any fault, defaults, errors, omissions or negligence of any person, school, association, company or other type of service provider used in connection with the delivery of the programme; nor for any loss, injury or damage to a person or property connected with accommodation, transportation or any other kind of service. Well-kept Secrets is not responsible, directly or indirectly for cancellations, delays, amendments, loss or additional costs incurred by participants due to acts of nature, civil unrest or disturbances, strikes, work stoppages, fire or arson, thefts or inclement weather.

PAYMENT: A 10% deposit or US$515.00 per person must be transferred to the following account at the same time as this Enrollment Form is returned to us. Confirmation of receipt of payment will be sent to you. All payments are to be made by direct bank transfer to our U$ account – see details below. The final payment has to be transferred no less than 21 days prior to the programme.

US$ DOLLAR RATES: The actual programme cost is based on the US$ dollar rate of exchange at the time of costing. The total rate may be subject to change in the case that the rate of exchange increases more than 5% or for an increase in fuel prices in Indonesia. If there are any changes, you will be informed if and when these are necessary.

US$ DOLLAR INDONESIAN BANK ACCOUNT DETAILS:
Please send us a copy of your transfer by email to: gusti@well-keptsecrets.info

Bank  : CIMB NIAGA
Bank Address : Jalan M.H. Thamrin No. 77 Denpasar 80361, Bali - Indonesia
Acc. holder : CV. PURI GANESHA
Address : Desa Pemuteran, Gerokgak, Singaraja 81155, Bali - Indonesia
USD Acc. no  : 289.02.00232.00.2
Swift Code : BNIAIDJA
     
RELEASE & ASSUMPTION OF RISK:
I/We, the undersigned, have read, completely understand and agree to all the ‘Terms & Conditions as stated in this form. 1/we acknowledge that the programme for which we herewith enroll, under the arrangements of ‘Well-kept Secrets’ involves certain inherent risks and dangers including but not limited to those listed under ‘Terms & Conditions’ on the previous page. In consideration of, and as part payment for the right to participate in the programme in which I/we herewith enroll, I/we have and do hereby assume all risks of travel, specified or unspecified, expected or unexpected and will hold ‘Well-kept Secrets’ harmless from any and all liability, actions, causes of action, claims, debts or demands of any and every kind and nature, which I/we now have or may arise in connection with the participation in the ‘Culinary Alchemy of the Archipelago’, or in any other activities suggested or actually arranged for me/us by ‘Well-kept Secrets and their employees, agents or associates. The terms hereof shall serve as a release and assumption of risk by and for me/us, for my/our heirs, assigns, executors and for all members of my/our families including minor children. My/our signature(s) here below acknowledge that  I/we have read and understood both this ‘Release and Assumption of Risk’ and the ‘Terms & Conditions’ in this form.

 

 

 


IN CASE A COUPLE/HUSBAND & WIFE WOULD LIKE TO ENROLL TOGETHER, EACH PERSON ENROLLING SHOULD SIGN PLEASE!!

 

Print first name Print last name  Signature Date
       
       
...........................................
       
       
Print first name Print last name  Signature Date
       
       
...........................................
       
       

Thank you so much for enrolling with us, all the details will be sent to you on receipt of your deposit.
WELL-KEPT SECRETS

 

WELL-KEPT SECRETS www.well-keptsecrets.com   email: diana@well-keptsecrets.info

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