Tour Name:

Tour Dates:

Your Name:

Address:

City/State/Zip:

Phone:

Smoking(s)/ or Non-Smoking:

I will be rooming with:

Name Tag Name,
if different from above:

Indicate special events during the tour such as birthdays, anniversaries, retirement, etc.:

Responsibility:  Please initial at the end of this sentence indicating that you have read, understand and agree to the “Responsibility” statement on the tour itinerary.  ___­­_

Travel Protection Waiver:  Would you like Cancellation & Travel Insurance mailed to you? ______

If declining insurance, please sign here indicating you’ve declined.

Client’s Signature:

Date:

Small surcharge to use Visa or Mastercard. If desired:

Card #:

Card Billing Zip Code:

Type of Card (MC or Visa)

Today’s Date:

Expiration Date:

Signature: