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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 – firstname.lastname@example.org – 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: Province: 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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