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Creating memories...one vacation at a time!

    THE INSIDER’S TOUR TO TAHITI  WITH DIERDRA McELROY
       
__ Yes, please sign me up for the Insider’s Tour to Tahiti with Dierdra McElroy.
              __ I can’t go with the group this time but keep me informed of other quilting trips
 __ I would be interested in an independent Tahiti trip.

PLEASE FILL OUT AN APPLICATION FOR EACH TRAVELER

This application will secure yourself a place on the tour and information will be sent to you.  Please fill out this form and return it to the address below.  
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GENERAL INFORMATION:

Name:_______________________________________________________________________________

Address:____________________________________  City: _________________  State: ___  Zip: ________

WPhone:____________ HPhone:________________ Cell:  ______________E-mail: ___________________

Best time to contact you: _________________________________
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HOTELS

InterContinental Tahiti Resort Room Categories:
  __ Garden Room -  Other categories are available (Lagoon, Panoramic,                     Overwater Bungalow
InterContinental  Moorea Resort Room Categories:  __ Lanai Room -  Other categories are available (Garden bungalow, Beach            bungalow,  Beach bungalow, Overwater bungalow - call for pricing.  
My roomate will be: _______________________    __ I will need a roommate (roommates will be provided if at all possible.                            Otherwise the single occupancy rate will apply.)
I want single occupancy.   Please call for pricing.
 
Bedding: __ 1 bed - King or Queen        __ 2 beds - doubles         __ Nonsmoking         __ Smoking    
       
SPECIAL REQUESTS:_____________________________________________________________________

SPECIAL NEEDS: ________________________________________________________________________
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AIRFARE INFORMATION:   Your Travel Source can arrange for your airfare from your hometown to Los Angeles. 

__ I do not need airfare.   __ I would like Your Travel Source to arrange for my air.  If you make your own arrangement, please submit your flight schedule to Your Travel Source.

Departure Airport: ______________________          Alternative Airports: _____________________________________

Seats:    __   Window     __  Aisle       Meal Requests:   ________________________________________________________

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EMERGENCY CONTACT:

Name: _________________________________________________________  Relationship: ____________________

Phone Number:  __________________________________ Email Address:___________________________________

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 CREDIT CARD INFORMATION:
  We will ask for this information once the tour has been confirmed.

T
ype of Credit Card:  MC   VI    DI  AX #: ____________________________  Exp. Date: __________   Sec. Code: _____

 Your name as it appears on your credit card: __________________________________________________________

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TRAVEL EXPERIENCE:  __ I have traveled internationally before.    __ I have not traveled internationally before.   Please give us some idea of other trips you have taken.

_______________________________________________________________________________________________

_______________________________________________________________________________________________
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PASSPORT INFORMATION:
You must have a passport to go on this tour.  If you have an existing passport, it must have
at least 6 months left on it from the day of departure.  If you need to get a new passport or renew your passport please allow 8 weeks.  You can apply at your post office.  

Passenger:____________________________________________  ____________________  ___________________
                                  First & Middle Name             Last Name                                                 Passport Number                          Date of Issue      

_________________  ______________________   __________________________   __________________________
  Where Issued                        Expiration Date                                     Citizenship                                                            Birthdate

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Please fill out this form and include a copy of the name page of your passport (the page that includes your full name and expiration date)  and send to Your Travel Source at 2923 Carmel Way, Fairfield, CA   94534-1712.    Before sending, please read the Terms and TCRC.    

I have read the Terms and Travel Consumer Restitution Information (TCRC).

______________________________________________________                                                                                                                                                                                 Signature            

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