Name:
Address:
Email Address:
Phone Number:
Number of Children in Group:
Ages of Children:
Total Number in Group:
Dates Required:
Special Requirements: (Please state details)
Meal on Arrival?	Yes/No
Chambre D'Hote?	Yes/No
Veg and Egg Hamper Required?	Yes/No
Amount of Deposit Enclosed:

A non returnable deposit of £100 for each week will be required.

Please return this form and Cheque (payable to D.J.Hosie) to:-

A.Paysse
Aussat
32170 Aux-Aussat,
The Gers.
France