Name as you would like it to appear on your Nametag
Date of Birth
Cell Phone Number
Who would you like to share a room with?
Do you wish to have a room near certain other Travelers?
Do you have any special requests (Ex. Diet)?
(Check one for each category)
Double Triple Quad Single
1 Bed 2 Bed
PLEASE NOTE: We recommend the purchase of travel protection. This coverage protects you financially if you should have to cancel or interrupt your trip due to an unforeseen circumstance or if you need to seek medical attention while traveling. To determine the cost of protection per person, please see the brochure for the specific tour you are signing up for. Payment of protection premium at the time of deposit waives the ‘Pre-existing Conditions’ clause. Protection is not considered ‘Accepted’ until it is paid for. Please read through travel protection to better understand the coverage.
I accept Travel Protection I decline Travel Protection
To view policy/certificate for refund information go to www.tripmate.com/wpf428r
Our preferred method of payment is by check.