(U.S. citizens require a valid U.S. passport for this itinerary)

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: