Please use this form to check availability. We recommend you to book your flights ONLY AFTER you have received a confirmation of your booking from us. Special Offer From 1 October to 15 January 2018 50% off for an extra night and a complimentary foot massage on the arrival day. All fields marked with an asterisk ( * ) are required. The Panchakarma of your choice * I want to book a Panchakarma for ---710142128other nights N.B. Menstrual cycle. Please note that your first four days can interfere with your treatments (for 7-10 day stays). Choose your dates of arrival and departure and keep in mind the complimentary night/s before or after your Panchakarma. * Arrival date * Departure date Arrival flight Arrival time Departure flight Departure time I am already in Bali. Please pick me up at Hotel name Hotel address *Room type Single occupancy Double occupancy (1 bed) Twin share (2 beds) Only available if you already have a roommate. We do not offer sharing rooms with strangers. **Please note: Each participant must fill out a form Your Personal Information *First name ---Mr.Mrs.Ms. * Family name * Date of birth ---12345678910111213141516171819202122232425262728293031 ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---19301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000 Home address * City * Country ---AfghanistanArgentinaAustraliaAustriaBahrainBangladeshBarbadosBelizeBelgiumBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaCanadaCentral African RepublicChileChinaCubaCzech RepublicDenmarkFinlandFranceGermanyGreeceHaitiHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic Of)IraqIrelandIsraelItalyJamaicaJapanKorea, Republic OfKuwaitMalaysiaMexicoNetherlandsNew ZealandNorwayPhilippinesQatarRussian FederationSaudi ArabiaSingaporeSouth AfricaSpainSwedenSwitzerlandTajikistanTaiwanThailandUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesOther * Home phone number Office phone number Mobile phone number * Email address * Re-type email address Name of contact person in case of emergency Contact person phone number Contact person email address Additional Information * Have you done a Panchakarma before? Yes No * Have you attended one of Oneworld's Retreats before? Yes No Do you have any serious health issues that we should be aware of before your arrival? Food allergies / diet restrictions Please note that we serve food based on Ayurvedic principles, mostly vegetarian. Your allergies and diet restrictions will be discussed in detail during your initial consultation with the physician. * Your clothes size ---SMLXLXXL (You will receive a tunika and pants set to wear) * Your shoe size (You will receive a pair of flip-flops to wear) EU US UK/AUS Special requests Please explain if you have any physical disorders that we should be aware of. Our resort is located on a hillside and has many steps. It is not accessible for wheelchairs. * How did you hear about us (Please be specific e.g. Google, website, magazine, ONEWORLD ambassador, friend's name etc.) * On which device did you access our website? ---PC/MacTablet/IpadMobile phone Participant disclaimer Risks, Cancellations and Insurance Panchakarma participants assume complete and full responsibility for, and hereby release Oneworld Ayurveda, PT. Zen Jiwa Raga, Abing Resort, the owner/s, the employees or anyone involved in supplying any services during the length of the proposed travel. Oneworld Ayurveda, PT. Zen Jiwa Raga, Abing Resort shall not be responsible for any injuries, losses or damages in connection with accommodations, other facilities at the resort, ground transportation, diseases, local laws, climatic conditions, Acts of God, delays, changes or cancellation of travel due to weather conditions, accidents or health related problems while residing at Oneworld Ayurveda - and while in-transit to (e.g., an accident on the way to a tour), during, and after a tour, unless such injuries, losses or damages are due to the negligence or willful misconduct of Oneworld Ayurveda, PT. Zen Jiwa Raga, Abing Resort. It is the travelers' responsibility to obtain appropriate insurance coverage against these risks. If travel plans are delayed or cancelled for any reason there will be no refunds issued by Oneworld Ayurveda except as stated herein. We specifically recommend that foreigners entering Indonesia do so with a valid Passport expiring more than six months following the departure date from Indonesia. Indonesia has a very strict policy on this and will refuse entry if this condition is not met. Oneworld Ayurveda is not responsible for expenses incurred in preparation for any cancelled trips by a guest such as airline tickets or for costs incurred due to travel delays, flight cancellation or illness. Cancellation by Oneworld Ayurveda Oneworld Ayurveda will do its utmost to maintain its standard of never cancelling a panchakarma, but if for some unforeseen reason Oneworld Ayurveda were to ever cancel a panchakarma, guests are welcome to move panchakarma dates or their payment will be refunded in full. Payment of your deposit indicates your agreement to the cancellation policy. Cancellations by guests A non refundable deposit of USD 700 is requested to secure your booking. This is paid to Oneworld Ayurveda's PayPal account or bank account. The remainder is to be paid upon arrival by cash, Visa or MasterCard. Oneworld Ayurveda does not offer refunds for any reason. A portion of your payment may be used as a credit for another panchakarma within 12 months of the original panchakarma date. Depending on when you cancel, cancellation penalties may apply. Fees are determined by the following schedule: • For cancellations made more than 90 days prior to panchakarma start date, 100% of your deposit payment may be applied to another panchakarma. • For cancellations made between 89 and 31 days prior to the panchakarma start date, 50% of your deposit payment may be applied to another retreat. 50% of the deposit is non refundable. • If you cancel 30 days or less before your panchakarma start date, the entire of the deposit is non refundable. Exceptions to our policy cannot be made for any reason. We do not offer credit for arriving late or leaving early. There are no partial refunds for any services not used while the panchakarma is going. I have read and agree to the Retreat Participant Disclaimer Note: You will be asked to sign the disclaimer upon arrival at the resort. We will get back to you within 48 hours regarding your booking.