RESERVATION FORM					Payments
To make a reservation request, please fill out completely and submit the form below or make your reservation otherwise. Please note that this form does not guarantee a reservation. We will verify availability and send you a reservation confirmation to the email provided.
1 – About you	2 – The retreat			3 - Submission
First name	Motivation	Tobacco	Vegetarianism	Comments or questions Notes : • You can accept without worry the warning messages that may appear during the submission process. Information provided is confidential. • Non-refundable deposit of $200 per person required with each reservation. Consult the complete conditions here.
Last name		Disease	Detoxification
Address		Rest	Other
City	Fast	10-day 14-dayJuice
Province	Session	11 au 20 novembre 9 au 18 décembre 6 au 15 janvier 2011 10 au 19 février 10 au 19 mars 7 au 16 avril (jeûne ou jus) 5 au 14 mai 19 au 28 mai 9 au 18 juin 7 au 16 juillet (jeûne ou jus) 21 au 30 juillet 11 au 20 août 8 au 17 septembre 6 au 15 octobre (jeûne ou jus) 10 au 19 novembre 8 au 17 décembre
Postal Code	Room	Private Shared
Telephone	Treatments	Package Undecided
Email	Number	0 1 2 3 Irrigations 0 1 2 3 Massages
Age	You will be able to make changes to the number of treatments on-site, according to circumstances.