Application Form 
See also:      Registering for the Tour    Conditions of Travel   Liability Waiver
 
YES!  I want to join Serenity Transformational Tours 13 day Journey and Journal Tour to Bali
on (date):____________________
     I am securing my place in the tour with US $500 deposit (see below)
    

I understand that final balance depends on the number of people travelling and is to be paid no later than 3 months before departure   


PAYMENT OF DEPOSIT
  I am enclosing a non-refundable deposit of US $500 to reserve my place in the tour:
  I am paying by (Please tick appropriate box)   Money Order   Certified Cheque  Credit Card (See next line)
    Please charge US $500 to my  VISA   Mastercard Account
    Account number: _______ _______ ________ ________ expiry date: _________ 

    I have read and understand the information and accept the terms and conditions that are set out in the Serenity Transformational Tours materials, in particular The Tour details (http://www.serenitybythesea.com/tour-details.htm)
Conditions of Travel (http://www.serenitybythesea.com/conditions.htm ) and
Liability Waiver (http://www.serenitybythesea.com/liability.htm) for this tour. NOTE: If you need more information or you cannot access these materials phone toll-free1-800-944-2655 or email serenity@gulfislands.com

    Signature: ____________________________   Date:  _____________________

PERSONAL INFORMATION
Name (in passport): Preferred Name:
Passport No.: Nationality: Country of Birth:
Profession: Sex: Age: Date of Birth:
Phone-Home: Work:
Cell: Fax:
Street: City
State/Province: Country: Postal Code:
Email: Website:
EMERGENCY CONTACT  (WHILE TRAVELLING)
Contact Name: Relationship:
Phone: Home: Work: Cell:

WHEN YOU HAVE COMPLETED AND SIGNED THIS FORM AND THE LIABILITY WAIVER, FAX IF PAYING BY CREDIT CARD (250-539-2655), OR SEND TOGETHER WITH YOUR CHEQUE OR MONEY ORDER TO:
SERENITY TRANSFORMATIONAL TOURS
225 SERENITY LANE, RR2 GALIANO ISLAND 42-14, BRITISH COLUMBIA CANADA V0N 1P0