<font face="Verdana" size="3"><b>Biennial Booking Form</p></font></b>

<font face="Verdana" size="2">Please complete the details below to make your booking. For security we will call you for your credit card details so you do not need to enter them on-line. If you have any questions please call Mike or Penny Beral, 01923 855367, or email <a href="mailto:m.beral@liberaljudaism.org?subject=Biennial Enquiry">
m.beral@liberaljudaism.org</a>.</font>

Name of First Participant
(as you would like it to appear on your badge) *
Second Participant (if any)
Address *
Phone (evening) *
Email *
Child's name and age (1)
Child's name and age (2)
Community of which you are a member (if any) *
Specific accommodation requests, mobility constraints,
dietary requirements or anything else we should know
Room type *
 Double 
 Twin 
 Single 
 Family 
 Connecting room(s) 
 willing to share 
 Day visitor 
Staying Sunday night? *
 Yes 
 No 
Phone number to call you on for payment details *
Best time to call you *
Image Verification
captcha
Please enter the text from the image:
[Refresh Image] [What's This?]
Powered byEMF Contact Form
Report Abuse