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Autism Ontario Disney Vacation Booking Form


									                     Autism Ontario Disney Vacation Booking Form

Please complete this booking form in CLEAR printing, or by typing on the computer.
Please e-mail to Wendy Steppler – – quoting “Autism
Ontario Family Booking” in the subject line OR fax to 807-623-7709 to the attention of
Wendy Steppler.

Family Information: Please complete EXACTLY as shown on passport)
   Last Name             First Name        Date of Birth      Passport No. &
                                          (dd/mm/yyyy)           Expiry Date

Home Address                                   Phone Number: (          )
                                               Alternate Phone: (        )
                                               E-Mail Address:
Postal Code:
Accommodation Package Choice:                  Meal Plan Package Choice:
   □ 7 Night Package ($785.00)                     □ Disney Dining Plan
   □ 4 Night Package ($470.00)                     □ Wine & Dine Plan
                                                   □ Other (contact for details)
Disney Park Pass Choice:                       Flight Choice:
   □ 7 Day Pass                                    □ Yes – I’d like to book air travel (an
   □ 4 Day Pass                                       agent will contact me with details
       □ Add Park Hopper Option                       as group rate is SOLD OUT)
       □ Add Water Park Option
   □ Other (contact for details)                  □ No air travel booking
Travel Insurance Choice:                       Credit Card Information:
   □ Yes – Plan 1                                 □ VISA            Expiry Date:
   □ Yes – Plan 2                                 □ MC                       /
   □ Decline                          .           □ AMX             Security Number:
            Please initial if declining.
Name on Card (exactly as it appears):
Credit Card Number:
                                               Thank you for your booking! You will be
                                           .   contacted soon after we receive your
          Signature of Card Holder             booking sheet! Have a great day!

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