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This application will secure yourself a place on the tour and information will be sent to you. Please fill out this form and return it to the address
below. When it is time to start booking, you will be contacted to see if you are still interested. At that time we will take down your credit card information. We
need at least 16 people to make this tour a reality so please share the information about Didi's tour with your Quilt Guilds and friends.
.
GENERAL INFORMATION:
Name:__________________________________________________________________________ _______________
Address:____________________________________ City:
_______________________ State: ___ Zip: __________
WPhone:__________________________________ HPhone:____________________ Fax:_______________________
E-mail: __________________________________ Best time to contact you:
____________________________________
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HOTELS
q InterContinental Tahiti Resort Room Categories: q Garden Room - Other categories are available
(Lagoon,
Panoramic Room, Overwater Bungalow.
q InterContinental Moorea Resort Room Categories: qLanai
Room - Other categories are available
(Garden
Bungalow, Beach Bungalow, Overwater Bungalow - call for pricing.
q My roomate will be: _______________________ q I will need a roomate
(roomates will be provided if at all possible. Otherwise the single occupancy rate will apply.)
q I want single occupancy. Please call for pricing.
q Bedding: 1 bed - King or Queen q 2 beds - doubles q Nonsmoking q Smoking
SPECIAL REQUESTS: ___________________________________________________________________________
SPECIAL NEEDS: _______________________________________________________________________________
_
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AIRFARE INFORMATION: Your Travel Source can arrange for your airfare
from your hometown to Los Angeles.
q I do not need airfare. q I would like Your Travel Source to arrange for my air. If you make your own arrangement, please submit your flight schedule to Your Travel Source.
q Departure Airport: ______________________ Alternative Airports:
_____________________________________
Name as it appears on your drivers license:______________________________________________________________
Seats: q Window q Aisle Meal Requests: ________________________________________________________
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EMERGENCY CONTACT:
Name: _________________________________________________________ Relationship: _________________________
Phone Number: __________________________________E-mail Address:________________________________________
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CREDIT CARD INFORMATION:
Type of
Credit Card: MC VI DI AX #: ________________________________ Exp. Date: _______________ VID: _____
Your name as it appears on your credit card: _____________________________________________________________
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TRAVEL EXPERIENCE: q I have traveled internationally before. q I have not traveled
internationally before. Please give us some idea of other trips you have taken.
_______________________________________________________________________________ __________________
_______________________________________________________________________________
__________________
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PASSPORT INFORMATION: You must have a passport to go on this
tour. If you have an existing passport, it must have
at least 6 months left on it. If you need to get a new passport or renew your passport please allow 10 weeks. You can
apply at your post office.
Passenger:____________________________________________ ____________________
___________________
Name as it appears on your
passport
Passport Number Date of
Issue
_________________ ______________________ __________________________ __________________________
Where
Issued Expiration
Date
Citizenship
Birthdate
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Please fill out this form and include a copy of the name page of your passport
(the page that includes your full name and expiration date) and send to Your Travel Source. Before sending, please read the TCRC Disclosures and the Terms & Conditions. Go to
the top and click on Terms and TCRC or click here to get to the TCRC page or Terms page.
I have read the Travel Consumer
Restitution Information (TCRC) and the Terms & Conditions .
_______________________________________________________________________
Signature
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