Printable Registration Form http birdtreks com etc regisform html BIRD TREKS REGISTRATION FORM Airfare is payable by credit card We can accept only a check or money order for the deposit a by ChrisBirchall


									Printable Registration Form                                                                  

                                                                                             Airfare is payable by credit card.
                                                                                             We can accept only a check or money
          BIRD TREKS REGISTRATION FORM                                                       order for the deposit and tour fee.

          I/We wish to register for the following tour:
          TOUR NAME: __________________________________________________________________________
          TOUR DEPARTURE DATE: ________________________ TODAY'S DATE __________________________
          DEPOSIT ENCLOSED (check or money order only): $_____________ for ______ person(s).
          Balance is due at least 60 days prior to departure date.
          NAME(S): ________________________________________________________________ sex _______
          _________________________________________________________________________ sex _______
          ADDRESS: ____________________________________________________________________________
          TOWN: ___________________________________________ STATE: ________ ZIP+4: ____________
          PHONE: Home (___)______________ Business (___)______________ Cell (___)______________
          EMAIL ADDRESS _______________________________________________________________________
          ___ I wish to have a single room, wherever possible, at additional cost.
          ___ I have a roommate (name): _______________________________________________________
          ___ I wish BIRD TREKS to provide a roommate, but if none is available, I understand there will be no extra charge.
          I am a ____ non-smoker           ____ smoker
          Please list ALL health problems or special dietary needs:

          In case of emergency, notify:
          (Name)________________________________________________ (Relation)____________________
          For any international tour, including Canada and Mexico, we need your:
          Passport #___________________________________________ Country Issued ________________
          Your Complete Name as it is on Passport _____________________________________________

          I wish BIRD TREKS to handle my flight arrangements:
          ____ yes ____ no ____ only after my approval

          If yes or with approval, please complete the following information:
          Preferred Departure City/Airport ____________________________________________________
          Alternate Departure City/Airport ____________________________________________________
          Departure Date _____________________________ Return Date ____________________________
          Preferred Airline(s) ________________________________________________________________
          Frequent Flyer Number(s) ____________________________________________________________
          Seating Preference (please circle): Economy ________ First Class __________
                                                   Window _________ Aisle ______________
          Senior Citizen (62 years or older): _____ yes _____ no
          Preferred Payment of Airfare (circle one):
          Check     Money Order      Credit Card:    AmEx  MC       Visa
              Card # _______________________________________ Expiration Date: _____________________
              Name as it appears on the card: ________________________________________________

                     Please read the Release Form, sign, date and return with your deposit check/money order to:
                                 BIRD TREKS, 216 Spring Lane, Peach Bottom, PA USA 17563-4008
                                     Phone 717-548-3303 ~ Fax 717-548-3327 ~
                     We can accept a credit card for airfare, but require a CHECK OR MONEY ORDER for the tour fee.

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