Sicily 2020 Registration - Tour Plan Intermantion Tour Plan

Personal Information and Travel Preferences

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Name *

Date of Birth *

Gender *

Country of Citizenship *

Share Room With

Bedding Choice

One Bed

Two Beds

Mailing Address *

City *

State *

Zip *

Email *

Cell Phone

Home Phone

Emergency Contact Name and Phone *

Dietary Restrictions

Would you like to purchase group airfare (see pricing below)? *

Yes

Would you like a transfer from Richmond to Dulles? Cost is TBD based on number of passengers. *

Yes

Valid Passport (with at least 6 months validity from your return travel date) is required. Please attach a copy of your passport photo information page to this registration form.

Passport Photo Information Page

Maximum file size: 26.21MB

Payment and Credit Card Authorization

Payment *

Check

Credit Card

Check Info

I am enclosing Check #

in the amount of $

for

traveler(s).

(Minimum deposit $1,500.00 per person)

Credit Info

Charge my credit card for the deposit amount of $

for

traveler(s).

(Minimum deposit $1,500.00 per person)

Travel Insurance

I would like to purchase an Allianz Global Assistance Travel Insurance Policy to cover:

Insurance Coverage

Land Only

Land and Air Package

I will pay by

Credit Card

Check

Check Number

If Paying by credit card, please complete below

Credit Card Type

American Express

Discover

Mastercard

Visa

Credit Card Number

Expiration

CVC

Name of Cardholder

Billing Address and phone if different than registration

Would you like to use this card for all future payments?

Yes

I agree to pay according to the card issuer agreement. I understand and accept the tour plan international cancellation policy, passport requirements, terms and conditions.

Signature

Clear

Marketing Permission

I agree to the following marketing permissions:

Email Communications:

Yes

Inclusion in group directories:

Yes

Use of likeness in photographic marketing materials:

Yes

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