Please reserve me a place on: tour. Dates:

Name: Address:

Daytime Tel: HomeTel:

City/State/Zip: * Male/Female: Male Female

Nonsmoker? Email: Birthdate:

* Please find me a room-mate/cabin-mate OR I prefer a single room/cabin at a supplement if available.

* Please reserve me an Inside Cabin/Outside Cabin (if applicable).

* Enclosed please find my check for *$350/$400/$450 deposit (which includes a $50 non-refundable
registration Fee) OR please debit my credit card (VISA OR MASTERCARD ONLY) for this deposit amount OR I have already agreed to my credit card having been debited.

Credit Card No:   Security Code on Back:

Experation date:

All prices listed are cash discounted one and additional, individual amount will be given on confirmations, if final payment is made by any other method.

* I shall mail my check for final settlement of the balance BY 70 DAYS PRIOR TO DEPARTURE OR please charge this same credit card the balance at 60 days prior to departure. The balance and due date are to be found on your confirmation invoice.

If you have any dietary restrictions, please advise at this time.

If you have any physical limitations, please advise at this time.

I confirm that I have read and agreed to the terms and conditions set forth.

Signature