|
Please
print this form and submit it to the location specified below
FIRST NAME___________________________
LAST NAME__________________________ ADDRESS______________________________________________________________________
HOME TEL. NO.( ___) ___________________
WORK TEL.NO. ( ___) _________________
DATE OF BIRTH______________
OCCUPATION______________
NATIONALITY________________
PASSPORT NO.______________
PASSPORT ISSUED AT________
DATE ISSUED_______________
VISA NUMBER_______________
VISA ISSUED AT_____________
DATE ISSUED____________________________
IN A EMERGENCY, CONTACT:
FIRST NAME___________________________
LAST NAME__________________________ ADDRESS______________________________________________________________________
HOME TEL. NO.( ___) ___________________
WORK TEL.NO. ( ___) _________________
DO YOU HAVE ANY PRE-EXISTING
MEDICAL CONDITION?____________________________
ARE YOU PHYSICALLY FIT FOR
THIS HOLIDAY ?____________
TOUR CHOICE (PLEASE CIRCLE
ONE)
| 1.
RAJASTHAN TOUR-21 DAYS
Group category: [ ] 1-2
people [ ] 3-5 people
[ ] 12-22 people |
2.
PUSHKER CAMEL FAIR :- TRANSPORT TOUR.
(A) Program #1 (B) Program
#2
(C) Program #3 (D) Program
#4 |
| 3.
DESERT TOUR-14 DAYS
Group category: [ ] 1-2
people [ ] 3-5 people
[ ] 12-22 people
|
4.
A ROMANTIC DESERT ADVENTURE :-
OPTION 1: [ ] CAMEL SAFARI
AND X-MAS EVE
(DEC 22 TO DEC 26)
OPTION 2: [ ] X-MAS EVE
(DEC 24 TO DEC 26)
OPTION 3: [ ] MERRY CHRISTMAS
AND HAPPY NEW
YEAR
(HOLIDAY IN DESERT (DEC
24-JAN 01)
OPTION 4: [ ] CAMEL SAFARI
& NEW YEAR EVE
(DEC 29- JAN 01)
OPTION 5: [ ] NEW YEARíS
EVE
(DEC 31 - JAN 01)
OPTION 6: [ ] NEW YEARíS
EVE AND CAMEL SAFARI
(DEC 31 JAN 3) |
| 5.
CAMEL-SAFARI INTO THE THAR DESERT.
Group category: [ ] 1-2 people
[ ] 3-7 people |
6.
BED & BREAKFAST : ACCOMMODATION AT
DEEPAK
REST HOUSE, JAISALMER.
[ ] Single ROOM [ ] Double
ROOM [ ] Room number------- |
SPECIFY THE DETAIL ____________________________________
DATE OF DEPARTURE_____________
DEPOSIT 10% [ NOT REFUNDABLE
] PER PERSON PER TOUR IS REQUIRED. IF A BOOKING IS MADE 4 WEEKS OR LESS
BEFORE THE DEPARTURE DATE OF THE TOUR THEN THE FULL AMOUNT IS PAYABLE AT
THE TIME OF BOOKING.
I ENCLOSE PAYMENT OF $______________REPRESENTING
DEPOSIT/FULL AMOUNT.
I WISH TO PAY BY(PLEASE
CIRCLE ONE) : CHEQUE / MASTERCARD / VISA / AMEX CREDIT / BANK TRANSFER
SIGNATURE________________________________
I UNDERSIGNED ACCEPT AND
AGREE THE BOOKING CONDITIONS AND REPRESENTATION MADE IN THE BROCHURE. I
AGREE TO PAY THE BALANCE OF THE TOUR COST 4 WEEKS PRIOR TO THE TOUR DEPARTURE
DATE.
SIGNED_______________________
DATE____________________
Make checks payable to Off
The Beaten Track
Send this form and all payments
to:
Off The Beaten Track
M.S. Vyas
55 South Street
Jamaica Plain, MA 02130
(617) 983-4090 |
