*Full Name

*Email Address

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*Arrival Date
This is the date of my arrival at S. Agatha.

*Arrive how? Arrive by Car at S. Agatha Arrive at Schiphol Airport in Amsterdam Arrive at Dusseldorf (Weeze) Airport (NRN) Arrive at Brussels Airport (BRU) Arrive in Cuijk by train
Please indicate above how you will arrive at S. Agatha
and indicate below if you need assistance upon arrival at airport

*Arrival Assitance No assistance needed-will arrive at S. Agatha on my own Please have someone meet me at the airport Please meet me at the train station in Cuijk

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Arrival Airport Arriving at Amsterdam Schiphol Arriving at Dusseldorf Weeze Arriving in Brussels
Indicate above at which airport you are arriving.

Arrival Flight
Indicate Airline and Flight Number.

Arrival Date

Arrival Time

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*Room Single Room at S. Agatha Single Room at Hotel Shared Room Room not needed
Indicate above your preference for housing.

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*Meals No special meals needed Low-fat meals Diabetic meals
Please indicate above if you have special dietary needs.

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*Departure Assistance No assistance needed-will depart with my own arrangements I need assistance to the airport I need assistance to the Cuijk train station
If assistance is requested, please fill out your departure information below.

Departure Date
Departure from S. Agatha and the Cuijk Hotel is scheduled for September 15th unless other arrangements have been made.

Departure Airport Depart from Amsterdam Schiphol (AMS) Depart from Dusseldorf Weeze (NRN) Depart from Brussels (BRU) Depart by train only (give preferred departure time below)

Departure Flight

Departure Time

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Other Requests/Information
Please indicate other information you wish to convey or questions you may have.

*Required