CITY, STATE, ZIP: _________________________________________ PHONE: _____________________________
E-MAIL ADDRESS: _______________________________________________________________________________
DATE OF BIRTH: ____________________ ALLERGIES OR MEDICAL PROBLEMS: ________________________ ________________________________________________________________________________________________
(Please note that this information is helpful to your tour escort and is confidential.)
I will be sharing a room with: _______________________________________________
I am traveling alone but would like to share a room if possible. _____ Yes _____ No
Smoking ____ Non-smoking ____ I would like a single room ($350.00 supplement). _____ Yes
* If, due to your physical condition, you require a shower rather than a bath, please check here. _____ (Every effort will be made to accommodate your needs.)
Name, address, phone number & e-mail of family contact in the U.S.: _____________________________________
COMPLETE THE FOLLOWING WHERE APPLICABLE:
Please arrange my airfare, departing from and returning to:
(City) _________________________________________ (State) ___________________________________
Departure: June 15, 2013. Return: June 27, 2013. If you prefer an earlier departure or a later return, please complete:
Departing: ______________________________ Returning: __________________________________
I will require accommodation at Bewley’s Hotel, Manchester Airport for ___ night(s) BEFORE the tour.
I will require accommodation at our selected London hotel for ____ night(s) AFTER the tour.
I want to participate in the optional outing to the British Library in London on June 27, 2013. ____ Yes ___ No
I/We have read and agree to the responsibility clause and to the booking conditions as stated. Please find $400.00 deposit per person enclosed.
SIGNATURE(S): ____________________________________________ DATE: _______________________
Please mail registration form and deposit payment by check or money order to:
11813 Erwin Avenue, Cleveland, Ohio 44135
Phone: (216) 889-9392; E-mail: email@example.com