Venue Bali Lodge Company / Private Private Company Name Telephone Fax Email Contact Person Number of Adults Number of Children (under 12 years) Number of Children (under 3 years) Arrival Date   Departure Date   Accommodation Type Self Catering Bed and Breakfast Number of Single Rooms (if applicable for groups) Number of Sharing Rooms (if applicable for groups) Include Lunch Yes No Include Dinner Yes No Special requirments