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###mr_mrs### ###title### ###surname###, We are very pleased that you decided to take a Maharishi Ayurveda treatment. We´ll contact you as soon as possible A confirmation of your instructions has been sent to you by email With warm regards, Maharishi Ayurveda Team in Bad Ems. Maharishi Ayurveda Gesundheits- und Seminarzentrum Bad Ems GmbH. Staatlich anerkannte Privatlkinik (§ 30 GewO) ###mr_mrs### ###title### ###surname###, we are very pleased that you decided to take a Maharishi Ayurveda treatment. We´ll contact you as soon as possible. With warm regards, Maharishi Ayurveda Team in Bad Ems. Your data: Title: ###title### First name: ###first_name### Surname: ###surname### Email: ###email### Street: ###street### ZIP: ###zip### City: ###city### Country: ###country### Telephone: ###phone### Healthins.: ###health_insurance### Regarding accomodation: ###room### Smoker?: ###smoker### Arrival date:: ###arrivaldate### Arrival time: ###arrivaltime### Departure date: ###departuredate### Message: ###message### Maharishi Ayurveda Gesundheits- und Seminarzentrum Bad Ems GmbH, Postfach 13 30, D-56120 Bad Ems Telefon: 02603 9407-0, Telefax: 02603 3122, info@ayurveda-badems.de, www.ayurveda-badems.de Geschäftsführer: Lothar Pirc - HRB Koblenz 4569, Leitende Ärztin: Dr. Karin Pirc

Eine Buchungs-Anfrage von Herr/Frau: ###mr_mrs### Titel: ###title### Vorname: ###first_name### Nachname: ###surname### E-Mail: ###email### Strasse: ###street### PLZ: ###zip### Wohnort: ###city### Land: ###country### Telefon: ###phone### Krankenvers.: ###health_insurance### Unterbringung: ###room### Raucher?: ###smoker### Anreisedatum: ###arrivaldate### um ###arrivaltime### Uhr Abreisedatum: ###departuredate### Nachricht: ###message###

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