Tour Interest Form

    Tour Name:
    Tour Date:
    Name:

    (Note: Please use name as it appears on your passport. Passports are required for ALL travel outside of Canada.)

    Date of Birth:
    Address:
    City:
    Province:
    Postal Code:
    Telephone Home:
    Business or Cell:
    Email:
    Passport #:
    Date of Issue:
    Issuing Country:
    Accompanying Passenger:
    Date of Birth:
    Passport #:
    Date of Issue:
    Issuing Country:
    Accommodations:
    Airline Seating Request (s):
    "Aeroplan #":
    Special Meal Requests or Allergies:
    In case of emergency, please supply a local contact:
    Name:
    Relationship:
    In case of emergency, please supply a local contact:
    Telephone Home:
    Telephone Business:
    E-Mail:

    PAYMENTS

    Please make tour and insurance payment cheques payable to Uniglobe The Premiere Travel Group. Costs and due dates are listed on trip brochure.

    Deposit:
    Balance:
    Insurance: (To be paid with deposit)
    Single Supplement
    INSURANCE
    Credit Card Payments (may be subject to surcharge—see brochure):
    Card #:
    Expiry Date:
    Security No.:

    Signature:
    Date: