| See also: Registering for the Tour Conditions of Travel Liability Waiver |
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YES! I want to join Serenity Transformational Tours 13 day Journey and Journal Tour to Bali on (date)_________________ |
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I am securing my place in the tour with CAD $500 deposit (see below) | |
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I accept that half the balance ($US 1,100) is due 60 days prior to departure and the remainder is due 2 months before the start date of the tour. (Please pay by Money Order (International Money Order from outside Canada.) |
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I am enclosing a non-refundable deposit of CAD $500 to reserve my place in the tour: | |||
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I am paying by (Please tick appropriate box) Money
Order
Certified Cheque Credit
Card (see next line) |
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| Please
charge CAD $500 to my VISA Mastercard
Account |
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| Account number: _______ _______ ________ ________ expiry date: _________ | ||||
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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: |
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