First Name: Last Name: E-mail Address: Telephone: Country: Number of Adults: Number of Children: Age of Children: Name of Dutch B&B: Location: Arrival Date: 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st January February March April May June July August September October November December 2007 2008 2009 Departure Date: 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st January February March April May June July August September October November December 2007 2008 2009 Rooms Required: SingleRoom012345 Double Room012345 Twin Room012345 Family Room012345 Triple Room012345 Requirements (Ensuite, etc): Comments: Please complete all fields