First Name (as shown on your passport)

Middle Name (as shown on your passport)

Last Name (as shown on your passport)

Sex:  Female        Male                    

Age

Date of Birth    

Permanent Mailing Address

City

State

Zip code

Country

Phone (Home):    
Phone (Work):                   

Fax

 
E-mail

Place of Passport Issue:
Passport No:
Expiration Date:

Tour Package Name

Departure from (city, state/province, country):

Return to: (city, state/province, country):

Starting Date of Your Tour:

Ending Date of Your Tour:

Please tell us if there are any other special arrangements that you would like:

Are you in good health for this tour?  

Do you have any special dietary requirements?

Person to contact in case of emergency
Name
Relationship (e.g. mother)

E- mail

Fax 

Phone (Home)
Phone (Work)

How did you hear about us?

Accommodation

 Mr. & Mrs.                  Roommate                Single ( you have to pay single supplement) 

Do you smoke?   Yes        No

If no, do you want a non-smoking Roommate?      Yes           No             Don’t Care

Total Deductions: US$

Amout of Your Deposit: US$

Date of your Deposit:

Form of Payment (check one):

 Bank Transfer         Personal Check       Certified Check  
 Wired Money          Money Order    

 Credit Card -  Visa     Master    Other

Bank Name:



Bank Phone:

Total Tour Cost: US$ 
(Bank charges must be paid by the applicant)

The balance for final payment: US$ 

 
I AGREE THAT:

1) The above information given by me in this REGISTRATION Form are true and complete.
2) I have read and accept the terms and conditions of this tour and will comply with the policies as stated.


_________________________________________________                                       _____________________________
Signature of Applicant / Parent or Guardian if under 18 years old                                 Date