Stepwell Individual Booking Form

Stepwell: Booking Form

To confirm your place on this trip please complete, e-sign and submit this form. We will be in touch with information about how to send your deposit and the next steps for your visit.
Which trip would you like to book?*

South India - Ports, Forts, Temples & Birds - February 2024Patterns in the Landscape - March 2024Enrichment in South India - July/August 2024A South Indian Food Safari - October 2024Seeds of Light - January 2025
Full name of applicant (as on your passport)*

First NameMiddle NameLast Name
Date of birth

DayMonthYear
Date
Address and postcode

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Telephone (Home)

Country CodeArea CodePhone Number
Telephone (Mobile)

Country CodeArea CodePhone Number
Email address*
example@example.com
Special requirements
Please briefly outline any special requirements you will have that are relevant to this trip eg: diet, accommodation, medication etc. (Received in confidence.) We will gather details of this information in our medical form to follow..
Would you like to opt for the single room supplement

YesNo
Room sharing: Please give a name of who you would like to share a room with during this study visit, if known. Please leave blank if you are not yet sure.

First NameLast Name
Could you please just outline a little about why you would like to join this trip?
Privacy Policy

At Stepwell we take your privacy seriously and will only use your personal information to provide the products and services you have requested from us.
Join stepwell's mailing list

From time to time we would like to contact you with details of other projects we are offering. If you consent to us contacting you via email from our mailing list please tick this box.
Booking submission - Name of the person undertaking the booking:*

First NameLast Name
I confirm that by typing my name in the box above I am signing this form electronically.
Date of booking form submission*

MonthDayYear
Date
Terms and conditions*
Should be Empty:

Stepwell: Booking Form