RESERVATION INFORMATION

THE TANTRA EXPERIENCE
BED AND BREAKFAST
RESERVATION FORM
(Both partners should fill out this form)

Date of arrival: ______________________ Date of Departure: ________________________

Name:_______________________________________________________________________
Last First Middle Initial

Address:_____________________________________________________________________ Street City State Zip Country

Telephone: ( ) - ( ) - ( ) - E-mail ___________________
Home Office Cell

Occupation:_______________________

Name of companion for The Tantra Experience: _____________________________

Name, telephone number and e-mail address of anyone we should contact in the advent of an emergency. (Optional)

If you wish to do any of the Tantra Experiences or Tantric Coaching that we provide, it would be helpful if you provided as much of the following information as you feel comfortable to do so.

Describe your relationship to your companion.

How long you have been together?

What is working and what is not, both generally in the relationship and in the sexual relationship in particular. Share whatever you feel is relevant to our assisting you.

If you are wanting us to provide a pleasure oriented Tantric experience that is not focused on personal or relationship transformation and skill development, this kind of information is not necessary, although it may be helpful if you choose to share it.

___ Room Rental ____ Number of Days

We have chosen Vacation Package Option # ________

If you are staying for 4 days or more, please say how many sessions you want and the length of the sessions.

___ Massage for one___ or two: ___ for male ____ or female ____

___ One and half hour session on “How to have an Incredible Date Night”

___ Tantric Date Night ___ number of hours

___ Introduction to Tantra and Tantra Puja for Two ___ Number of hours

___ Romancing your Relationship: How to create Lasting Intimacy, Passion and Pleasure ___ Number of hours

___ Private Tantric Coaching Session ____ Number of hours
Please name the session or sessions you wish to cover and answer the questions below.

If you are interested in a number of topics from different sessions and wish us to create one or more sessions covering these topics, please describe your choices.

Describe any health issues that each of you are dealing with and any medications that you are taking and state if they are having or may be having any impact on your sexual or emotional life and, if so, what this is.

State what your goals are from the coaching. How can we best help you? What problems do you want to overcome? What potentials do you wish to realize?

Describe any previous Tantra trainings or education you may have had

Have you had any personal or spiritual growth experiences or done any yoga or meditation? If so, please describe, and indicate the extent of, these experiences.

Payment by ___ cash ____ check ____ Visa ____ MC

Credit card information:

___ My partner is putting this on his/her credit card and so this section is not applicable to me

Name on credit card: _______________________________________

Credit Card Number: ________________________________________

Expiration Date: _______________________________

I have read the Cancellation Policy and agree to abide by its’ terms. I understand that I cannot do a charge back if I cancel my reservation or for any reason what so ever. I understand that I am buying the use of the room and the time of my hosts, as agreed to, and no guarantee is made or can be made with regard to my satisfaction. I understand that if any harm comes to the room or my belongings while it is in my keep that I can be billed for the expensed incurred by this on the credit card provided.

Signature_______________________________Printed Name__________________________

Date: _________________