Booking Form - Step 1 of 2

Please fill out all necessary fields carefully and truthfully.
The first three sections "personal data", "school" and "accommodation" must be filled out.
When you click 'send' at the end of this page, you will receive a confirmation e-mail within 15 minutes. If you do not get a confirmation within this time, you should contact us by e-mail to the following address:
Javascript should be activated, else this form cannot be processed correctly.

Personal data

Salutation:

Mr.

Ms./Mrs.

First name:

Surname:

Address:

Postal code:

City:

Country:

Telephone (p):

Telephone (o):

[optional - Office"]

Telephone (m):

[optional - Mobile"]

Fax:

[optional"]

E-Mail:

[VERY IMPORTANT"]

Birthday:

(dd.mm.yyyy)

e.g. 27.05.1978

Occupation:

[optional"]

Leisure offers


If the Academia Bipo & Toni's offers any trips or courses, I would be interested in the following:

Trips:	Jungle	~ USD 585,40 per week
	Costa / Baños	~ USD 250,00 per week
	Otavalo	~ USD 250,00 per week

Courses:	Dance course	USD 5,00 per hour
	Cook course	USD 6,00 per hour
	Guitar course	USD 6,00 per hour

Flight/arrival


Airline:		e.g. Iberia
Flight No.:		e.g. IB7367
Arrival date:	(dd.mm.yyyy)
Arrival time:	(hh:mm)

Final remarks

Do you travel in a group?

If YES, please enter the name or if available the booking number of the responsible person:

Discounts:

	I am booking online and therefore I benefit from original prices, i.e. no additional agency fees.
	Additionally (to the original prices), I benefit from a discount of 5%, because I am booking more than 120 lessons.
	Additionally (to the original prices), I benefit from a discount of 5%, because I am booking at least 120 days in advance.

I know "Bipo & Toni's" from:

Remarks / wishes:

[max. 1000 characters"]

I agree with the fact that this form is conveyed like a normal E-Mail message without additional encryption, since it does not contain personal data, which would be subject to data security.

Langue:

Heure Locale, Quito

Agenda

No event for today

Photos