(U.S. citizens require a valid U.S. passport)

Dr. Mr. Mrs. Ms. __________________________________________ Birthdate ___________

(Print complete name as shown on your passport)

Passport No. _________________ Expires __________ Occupation  _______________________

Dr. Mr. Mrs. Ms. __________________________________________ Birthdate ___________

(Print complete name as shown on your passport)

Passport No. _________________ Expires __________ Occupation  _______________________

   

Home Address_______________________________ City____________State ____ Zip_________

Mailing Address ______________________________City ___________  State ____ Zip_________

(If final documents are sent by UPS, they cannot deliver to a P.O. box.)

Phone: Home __________________    Business _________________    Cell ___________________

Email address: __________________________________________   Fax: _________________

Airline Mileage No. : ______________________________________________________________

(Specify no. for each person.)
                            Note: If you arrange your own air, please let us know as soon as possible.

Send us your flight itinerary once it is confirmed.

Hotel room preference:  Smoking _______      Non-smoking _______   

Other special requests: _________________________________________________________

Do you have any special dietary, medical or physical needs of which we should be aware? ____________________________________________________________________________

Please provide name, relationship, and phone number of person to contact in case of emergency: ____________________________________________________________________________

Please send:

 completed reservation form,  deposit of $500 per person, and  copy of your valid passport, to:

Phone:  (213) 680-0333 or (800) 334-4YTB (outside of local area)  Email: groups@yamatotravel.com 

CST # 1019309-10