Name(s): (required)

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Tel No: (required)

E-mail address

Holiday type or location?

Preferred Accommodation type

 Budget Hotel Mid-Price Hotel (Holiday Inn, Premier inn etc.) Premium priced Hotel (4/5 *) Bed & Breakfast Lodge/ Holiday park Holiday house

Preferred method of transport:

 Car Train Plane Bus Boat

Holiday Companion preference

 Male Female

Holiday duration (1 – 21 days)

Holiday Companion preference

Do you require the use of any equipment – i.e. Hoist, Commode etc
If yes please give details

Any other relevant information:

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