BBM Enterprises
 P.O. Box 2055 · Louisa, Virginia 23093
 Phone: 1-800-989-9028 or 540- 967-2281
 E-mail: travel@bbmenterprises.com


TRAVEL RESERVATION FORM


Fax: 775-239-5075

 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             Donít Care

Tour Cost per person: US$ Any Deductions
  Joint Application     Early Deposit     Other

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