Reservation form

Form:

Personal data:

Name:
Year of birth:
Name (2nd person):
Year of birth (2nd person):

Street no.:
Place:
ZIP Code:
Country:

Phone:
Fax:
E-Mail:

Specification of the stay:

Stay:
Term (from):
Alternative term (from):
Lenght of the stay:

Accommodation:

Spa hotel:
Class of the room:

Board:

Choice:

Specification:

Trial Spa Stay: In price

Extra services (not included in price):

Garage: Surcharge EUR 6 per day
Surcharge EUR 8 per day

Bus transport: Bus transport Vienna-Luhacovice EUR 28
Bus transport Luhacovice-Vienna EUR 28

Other remarks: