Double J’s Partner Dance Week
Booking form for 3rd-10th November 2012

At the 4* All Inclusive Hotel Mediterraneo
Only £465 per person

For those wishing to stay longer, additional nights
(before or after these dates) are available at £39-00 p.p.p.n.
Please make cheque payable to J.A. Pascoe and send to Nirvana, Ramsden View Road, Wickford, Essex SS12 0LD. Tel: 01268
561487 or 07879 660271. For those wishing to use online banking send your payment to sort code 20-04-96, account no. 73385442,
account name J A Pascoe, reference your surname and initials. Travel insurance is NOT included, please make sure you have
adequate cover. Final payment required by 1st August.

Name ……………………………………………………………………………………………………………………………………………………………………
Address …………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………….Post code…………………………………………….

Final payment £____________ Balance sent by - Cheque / Bank Transfer (Delete as applicable)

First & Surname(s) …………………………………………………………………………………………………………………………………
(as they appear in your passport)
Address …………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………Post code…………………………………
Tel. no. Home …………………………………………………………… Mobile………………………………………………………………
Email Address ………………………………………………………………………………………………………………………………………

Departure Airport ……………………………………………………………………………………………………………………………………
(Your preferred airport, subject to availability)
Number of nights……………….. From………………………………………………… To…………………………………………………
Special requests (not guaranteed)……………………………………………………………………………………………………………
Deposit sent by - Cheque / Bank Transfer (Delete as applicable)
Arjjaze