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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.
Type 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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