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Literary, Natural & Historical Landscapes Tour of Britain, Wales & Ireland, June 3-12, 2011 with Optional Scotland Extension, June 12-15, 2011

Personal Data


Legal Name
(as it appears on your passport)
Mailing Address
City, State Zip
Home Telephone
Email

Are you a US citizen?
Yes No
Date of Birth
(MMDDYY)


Male Female

Passport #
Country of Issue
Spouse or roomate's name
(as it appears on their passport)
Roommate's Mailing Address
Roommate's City,State Zip
Roommate's Home Telephone
Roommate's Email

Is your Roommate a US citizen?
Yes No
Roommate's Date of Birth (MMDDYY)


Male Female

Roommate's Passport #
Country of Issue

 

Emergency Contact Person (Not travelling with you)



Your Contact Name
Relationship to you
Address
City, State, Zip
Home Telephone

Work Telephone
Room mate contact name (If different from yours)
Relationship to roommate
Address
City, State, Zip
Home Telephone
Work Telephone

 

Travel Data

Accommodations: Twin Double Single
Program fee based on double occupancy
A Single will incur additional charges, inquire.

Additional Excursions: London Theatre Tickets Irish Cultural Night-Approximately $25 per event
Scotland Extension, $1500

Initial Trip Cost $3350
Scotland Extension ($1500)
Other Costs
(i.e. single room occupancy)
Total

Payment

Make all checks payable to Cross-Continental Travel and mail to:
Donna Frazer-Palmer/Cross-Continental Travel
34 Wright Court
Lakewood, CO 80228

OR

Payment via Mastercard/Visa or PayPal (a 3% fee will be added).

Timetable
Call

Release and Agreement

Don't forget to "sign" and submit your application.
By submitting this application you agree that you have read and fully understand the "Release and Agreement" and the "Booking Conditions" as supplied herewith, and agree to be bound hereby, and to comply therewith.

Signature Date

For information call (303) 988-5304 | cell (303) 519-9119 | fax (303) 825-1468 or email donna@crosscontinentaltravel.com.


Price and Details | Itinerary | Home
Phone (303) 988-5304 | cell (303) 519-9119
fax (303) 825-1468 | email donna@crosscontinentaltravel.com