Please complete and fax to Ciao! Travel at (619) 297-8114
Tour 1: Amsterdam & Brussels [ ] Tour 2: Ghent & Brussels [ ] Tour 3: A'dam, Ghent & Brussels [ ]
Mr. Mrs. Ms. Dr.__________________________________________________________________ Last Name First Name Middle Your name as it appears on your passport T-Shirt Size: Small [ ] Medium [ ] Large [ ] XL [ ] XXL [ ] Address: ____________________________City__________________ State___ ZIP_____________ Tour document delivery address-Signature required for deliveryBusiness/Day Tel__________________________ Home Tel ________________________________ Email:_______________________
………………………Traveling Companion………………………
Mr. Mrs. Ms. Dr.__________________________________________________________________ Last Name First Name Middle Your name as it appears on your passport T-Shirt Size: Small [ ] Medium [ ] Large [ ] XL [ ] XXL [ ]Address: ____________________________City__________________ State___ ZIP______________
Business/Day Tel __________________________ Home Tel ________________________________Email:_______________________
[ ] I/we wish to purchase a COMPLETE tour package, including round trip air transportation.
Please state any special dietary or physical needs for your flights: _____________________________
[ ] Please contact me regarding extending my tour itinerary to: ______________________________
TOUR PRICE ___________ X Number of Persons ___ = TOTAL ____________
A deposit of $500 per person or payment in full* is due with this form.
[ ] ENCLOSED PLEASE FIND MY CHECK FOR : [ ] DEPOSIT or [ ] PAYMENT IN FULL ( PAYMENT IN FULL GUARANTEES YOUR TOUR PRICE )[ ] PLEASE CHARGE: [ ] MY DEPOSIT or [ ] PAYMENT IN FULL
TO MY: [ ] AMERICAN EXPRESS, [ ] VISA [ ] MASTER CARD [ ] DISCOVER
Card Number:__________________________________________ Expiration date: ___/___
Name as on Card:__________________________________ Signature:____________________
Credit card billing address:_______________________________________________________
Total Amount Enclosed or Charged:__________________
Insurance: [ ] Please send a cancellation/health trip insurance brochure. Ciao! Travel strongly recommends trip cancellation, baggage, accident and health insurance to help safeguard your Jazz Europe vacation.
GBBT Tours are offered subject to the terms and conditions as published herein. CST-2010054-40