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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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Country:
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Home Phone:
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Work Phone:
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Cell/Mobile Phone:
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Fax Phone:
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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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Birthday (optional):
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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: $599) |
| I will be sharing with: |
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Colorado Springs Extension:
(check one)
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Double room ($399) |
| Single room ($548) |
| No |
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Where did you hear
about this trip?
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CANCELLATION CHARGES
Cancellation charges are $300 from May 7, 2007 to June 16, 2007. From June 17, 2007, 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 $300 deposit ($100 non-refundable). Balance is due on May 7, 2007. 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 May 7, 2007.
If you register for this trip after May 7, 2007, 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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