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Please fill in the on-line registration form and submit it to us. This will hold your place for 7 days.
To confirm your reservation, please print this form, complete it (please do not forget to sign it) and mail it to us. If paying by check, please include it with this form.
If you have any further questions, please e-mail us directly.
Thanks.
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First Name:
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Last Name:
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Address:
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Apartment #:
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City:
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State/ Province:
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ZIP/ Postal Code:
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- |
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Country:
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Home Phone:
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()- |
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Work Phone:
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()- |
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Cell/ Mobile Phone:
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()- |
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Fax Phone:
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()- |
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E-Mail (home):
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E-Mail: (work):
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Sex:
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Age:
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Smoker:
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Emergency Contact:
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Name:
Relationship:
Phone: ()-
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Hotel:
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Request a roommate |
| Single room (Supplemental charge: $749) |
| I will be sharing with: |
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Where did you hear
about this trip?
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CANCELLATION CHARGES
Cancellation charges are $250 from December 22, 2003 to February 1, 2004. From February 1, 2004, the total cost of the trip is non-refundable. Cancellation charges are regardless of circumstances. Therefore, we strongly recommend that you purchase travel insurance.
This application must be accompanied by a $250 deposit ($100 non-refundable). Balance is due on December 22, 2003. If you register for this trip after December 22, 2003, full payment is due with this application. If paying by check, please make check payable to Jewish Singles Vacations
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DEPOSIT PAYMENT
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| Payment Type: |
Personal Check AMEX |
| Amount: |
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| Credit Card Number: |
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| Expiration Date: |
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If paying by credit card, your credit card will be charged
when we receive your application.
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BALANCE PAYMENT
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| Payment Type: |
Personal Check AMEX |
| Amount: |
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| Credit Card Number: |
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| Expiration Date: |
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If paying by credit card, your credit card will be charged on December 22, 2003.
If you register for this trip after December 22, 2003, your credit card will be charged full payment when we receive your application.
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| When sending this form, please sign and date: |
| Signature: |
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| Date: |
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Make checks payable to Jewish Singles Vacations
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Jewish Singles Vacations
P.O. Box 211
Brookline, MA 02446-0002
Telephone:(617) 782-3396 |
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