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Today's date:
Name: ______________________________________Citizenship ______DOB:____________
Legal name as it appears on passport (no nicknames)
Mailing Address __________________________________________City/State/Zip:_______________________
E-Mail:
__________________________________Tel.__________________________
Cell:________________
Rooming with:
________________________________Tel._______________ Citizenship_________ DOB:
________
Emergency
contact (1st person) ___________________________________________________________________
name relationship telephone
Emergency
contact (2nd person)____________________________________________________________________
name relationship telephone
Land Package: ____ persons@ $2595.00 (double occupancy) Air
from Newark, NJ: ____ persons@$1350.00
Single Supplement - $650.00 (Limited!) ________
(We might be able to help you find a roommate. Please note if
you would like to room with someone.)
Insurance: ____ persons @ $225.00 per person
if double occupancy; $265.00 if single for land package only.
Insurance rates with air: Land + Air - Double - Per
Person: $295.00; Land + Air – Single: $365.00
Click here for
more info about the insurance plan.
Deposit: $350.00 per person
($450 if air is selected) upon reservation
(Deposit is refundable if reservation cancelled in writing before May 19, 2014.)
Final
Payment due May 19, 2014.
CHECKS MAY BE MADE PAYABLE TO: Traveling Troubadour.
Send to P. O. Box 3189, Staunton, VA 24402
Please charge my credit card
___Visa ___Discover ___Master Card
___American Express
(Note:
We may process your payment through Pay Pal.)
Credit Card #___________________________________________Exp.
Date___________
Cardholder’s name_________________________________
SIGNATURE__________________________________
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