Tour Registration Form

 NAME:  __________________________________________________________________________________________

STREET:  ________________________________________________________________________________________

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:

 

Linda Treybig

11813 Erwin Avenue, Cleveland, Ohio  44135

Phone:  (216) 889-9392; E-mail:  lntreybig@att.net