Application
for
"Home dinners in Wales"
In order to match you with your host family - please fill in all details below. Thank you.
Prices: Adults £30
  Children 8 - 14 £15
  Subsequent children u. 8 £5
  (1 child under 8 free)  
 
Party of : female  male

Age:

Party of: girls  boys

Age:
First name:
 Surname:
Street:
 Postal Code:
City:
 Country:
Tel:
 		 Fax:
 		 E-mail:
 
Hobbies:
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Arrival date:
 Arrival time:
 Departure date:
Request for specific date:
Staying in Hotel  Camping  Youth hostel 
Staying in private home - c/o Name
Street:
 Postal Code:
 City:
Smoker: Yes No Allergies - Which?
Handicap (Wheelchair etc.) - Which?