Availability enquiry form

I would like to enquire about availability for:  
Event type:
         
Event date: (1st Choice) Number of persons: - Drinks Party:   persons
Event date: (2nd Choice)   - Dinner:   persons
Event date: (3rd Choice)   - Evening:   persons
    Accomodation:
Your details:
Company name: City:
Surname: (*) Country:
First name: (*) Tel.: (*)
Street + house number : Fax:
Postal code: E-mail: (*)
         
Any other comments/queries: Please enter the characters shown in the box below (New image)
Characters:
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     (*) These fields may not be left blank    
Manoir du Capitaine  -  Chemin de Boulouffe 1  -  7181 Feluy  -  Belgium  -  T: +32 67 87 45 40  -  F: +32 67 87 45 50  -