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San Francisco and the Wine Country Tour
October 12, 13, 14, 2012

Personal Data


Name
Mailing Address
City, State Zip
Home Telephone
Email

Male Female
Spouse or roomate's name
Roommate's Mailing Address
Roommate's City,State Zip
Roommate's Home Telephone
Roommate's Email

Male Female

 

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
$950 Participation Fee based on double occupancy
A single is an additional $250.

Initial Trip Cost $950
Other Costs
(i.e. single room occupancy)
Total

Payment

Please 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).

Mailing or email deadline is September 1, 2012.

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.

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