trip

Registration & Payment Form
We Do Not Share This Information With Anyone. See Below
Fields marked *are required. Please fill as much of the questionnaire as possible. 04/16/2008

*Last Name	*First Name Title
*Group Name	*Travel Date: Reservation #
Tour Package Name				Resort Name
*Address				Apt. #
*City		*State			*Zip
*Birth Date	mm/dd/yy		*Country
*E-mail	Important! Please double check.		*Citizenship
*Day Phone			*Night Phone
*Best Time to Call			Fax #

Type of Room? # of People in room# of rooms:

Person # 2

Legal Name: Birth date: Citizenship:

Person # 3

Legal Name: Birth date: Citizenship:

Person # 4

Legal Name: Birth date: Citizenship:

Do you need airfare? If yes, closest major airport ?

Do You Want All Inclusive? Do you want insurance?

How Many Days Stay ?

Please indicate if special occasion you are celebrating near date

If So, Anniversary or Birth Date: mm/dd/yy Name:

Other Requests or Comments. Also, Please List Any or Special Diets Required. If you are pregnant, how many months will it be at the time of the travel date?
Do you need a handicapped room, portable crib, high chair etc?

Payment Information
The next step is to provide us with your credit card information. Credit card information can also be provided by phone
(847) 885-7540 or fax (847) 885-4775

Credit Card:
Card Number:
Card Expires:
Name on Card:
Address:
Address:
City/St/Zip:
Country:
Amount:	US DOLLARS

Please click the 'Submit' button only once, and wait for the confirmation page to appear This can take a while at busy times, please be patient.

We Do Not Share This Information With Anyone. Privacy Statement