LEGACY
Please complete this form and
return it with your deposit of US $300 to:
Legacy Tours, Inc.
Phone: 509-624-1889 Fax: 509-624-1885
Tour Destination: ____________________________
Tour Dates: ________________________
Name (as it appears on your passport): ______________________________________________
Mailing Address: _______________________________________________________________
City: _____________________________ State/Prv.:
_________ Postal Code: ______________
Day Telephone: ______ -_____-_________ Evening Telephone: _____-_____-________
E-mail Address: ________________________________________________________________
Occupation: ________________ Sex: ___ Birth Date: _______ Birthplace: _________________
Passport No: _________________________ Citizenship: _______________________________
Place of issue: ___________________ Date of Issue: __________ Date of
Expiration: ________
Name, address, e-mail, and telephone number can be shared with participants of
the tour: (___)
I acknowledge
I have not been recently treated for, nor am I we aware of any
physical or emotional condition that would create a hazard to myself, or to
other participants and guides while on tour: (___)
Special Requirements:
________________________________________________________________
--Share double room with
Spouse/Companion: (___) Name: __________________________________
--I request a single room at an additional single supplement cost to me [when
available]: (___)
--I would like to share double room with another tour participant as yet
unknown to me: (___)
Please Note: Tour prices are based on double occupancy, so all
single travelers will incur an additional single supplement cost when a roommate
is not available from among the pool of tour participants.
Deposit enclosed: US
$300 (non-refundable) per tour registrant: (____) Check
Credit Card Payment: (____) Visa (____)
MasterCard Expiration Date: _______________
Bankcard Number:
______________-_______________-_______________-_______________
Name as it appears on Credit Card:
________________________________________________
Billing address (if different than home address):
______________________________________
I acknowledge that I have read
the INFORMATION AND CONDITIONS supplied to me by Legacy Tours, Inc. (see Terms
and Conditions #4100). I understand that the terms of this agreement are contractual, and that by signing this form I accept and
affirm that I am subject to the Terms and Conditions as recorded and presented
to me by Legacy Tours, Inc.
Name:
_____________________________________________________________________________
Print Name: ________________________________________________________________________