BOOK A ROOM Check in date Night Adults Children 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 012 Access code/IATA code: Cancel|Options/Languages Jl. Cocoa 2, No. 77 Banjar Bunutan, Desa Kedewatan P.O. BOX 999, Ubud 80571, Bali - Indonesia Phone.: +62 - 361 978839 Fax. : +62 - 361 972717 info@balipayoganresort.com www.balipayoganresort.com         August 2008   S M T W T F S           1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31	Reservation Personal Information Name *** Address Phone /Fax Email *** Flight Information Flight Number Arrival Date/Time Departure Date/Time Reservation Information Check In Date Check Out Date Room Choice -- please select -- Muladhara Chakra Anahata Chakra Ajna Chakra Sahasrara Chakra Manipura Chakra Number of Room Number of Person Remarks Please Enter Code Below ***     *** is required form	Special Offer
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