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SUMMER & FALL 2012 - VOLUME 3 - Senior Tours Canada

SUMMER & FALL 2012 - VOLUME 3 - Senior Tours Canada

SUMMER & FALL 2012 - VOLUME 3 - Senior Tours Canada

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REGISTRATION FORMTour Destination _______________________________________________________Departure Date __________________________ Total Cost $___________________✄ ✄Full name (as is on your passport)Traveller #1 ____________________________________Traveller #2 ____________________________________(spouse only, if applicable)Name you like to be called(for your name badge)__________________________________________Date of birth ... Traveller #1 ___________________ Traveller #2 ___________________Address ________________________________________________________________Telephone Number________________________Email___________________________Name of your partner (if not a spouse) _________________________________________Passport # (if applicable). Traveller #1 ________________ Traveller #2 ________________Expiry date. Traveller #1 ________________ Traveller #2 ________________Nationality. Traveller #1 ________________ Traveller #2 ________________If you wish to decline our comprehensive insurance plan (see Page 1), or to be covered onlyfor cancellation prior to the tour, the rebate amount will be advised by your Tour Consultant.)Put an “X” here if you wish to decline our comprehensive insurance policyor here if you wish to be covered only for cancellation prior to the tourSpecial requests _______________________________________________________________________________________________________________________________I enclose a cheque for $__________________ payable to <strong>Senior</strong> <strong>Tours</strong> <strong>Canada</strong>Make all payments by cheque, by final payment due date, deduct $50 person.or please charge $_____________ to my VisaMastercardCard # __________________________________Expiry Date _____________✄For final paymentorI will send a cheque in before the balance due datePlease charge the above credit card on the finalpayment due date for the balance owingSignature ________________________________ Today’s Date __________________For those paying by credit card: I understand that signing above is the equivalent of signing an actual credit card sales slip.

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