Tour - Registration Form

Please register me for the ______2005

Name as it appears on your passport
Address
City / State / ZIP
Enclosed is / deposit $1000 in full
MC / VISA / Check / money order / credit card
# ______
EXP ____/____
Contact Numbers & Info / Daytime / Evening
Mobile / Cell / Fax
Email Address
I heard about the tour by /

A Friend or Referral YES / NO If so, who?

Search Engine or Other? YES / NO If so, details?
Flight Information
* Do not purchase flights until tour confirmed
see Payment / Terms below / I have booked my flights to / from ______
Airline / Flight #
Arrival Date/Time / Departure Date/Time
Room Mate Preference / I have a Room Mate – Name: ______
We would like:  2 Single Beds  1 Double Bed
 Please choose a room mate for me  Smoker Non-Smoker
 I will have a single – please contact us for price of single supplement
Dietary Requirements /  I east most everything /  I do not eat red meat
 I do not eat eggs /  I do not eat chicken / turkey
Other Dietary Restrictions:
Emergency Contact Information
Please give the name, address and phone for a person we can contact while you are on tour / Name
Daytime Phone / Evening Phone
Email Address
Previous Tours /  I have been to ______before – which tours?
 I have been to other places – where?
Group Mailing List / To help you stay in touch with your new friends, we will be compiling and distributing a list of participants. It will include your details. The list will only be given out to the participants on this tour.
Please Include me on this list Exclude me on this list
PAYMENT / TERMS: A deposit of $1000 in US funds only, is due at the time of registration to reserve your place. You may pay by credit card, bank transfer or check. Please make your check (in US funds) (personal checks, bank checks, Money Orders or credit cardchecks) payable to: The Heart. The remainder of the tour fee, plus any applicable single supplement is due two weeks prior to tour date. Your depositconstitutes an agreement to pay the remaining amount due. Cancellations must be madein writing. Any cancellations made after full payment due date will carry a $200 non-refundable fee. You will be sent a welcome packet upon receipt of your deposit containing any further details needed.
* Tour pricing is based upon minimum number of participants. Should the number of registrants rise above minimum; the tour pricing will be reduced for each person. If less than the minimum participants have registered by deposit date the tour may be cancelled. Those who have registered will be notified of any such cancellation and any deposits made will be returned in full.
Make a copy of this form for you records. Use the shopping cart feature for credit card deposits or mail copy of form with payment to:
The Heart - 1115 High Street #12 - Auburn,CA95603USA
Telephone in the USA: 1 (530) 823-3352 or email to or in Australia61-2-9976-2165