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REGISTRATION FORM
PEG DOLAN’S IRELAND
SEPT. 14 – 26, 2015
$3,150.00 per person

NAME(1)______________________________________________________________________________________________________
		                  PLEASE PRINT NAME EXACTLY HOW IT APPEARS ON YOUR PASSPORT

ADDRESS:_____________________________________________________________________________________________________

CITY:___________________________________________________________STATE:______________ZIP:_____________________

PHONE: (home)_____________________________________________cell_______________________________________________

EMAIL:__________________________________________________________________________________________________________

PASSPORT NO:_______________________________________________________EXP. DATE______________________________

DATE OF BIRTH:____________________________________________________(this is required by the airlines)

MALE:______________   FEMALE:_______________U. S. CITIZEN __________YES   ___________NO

I WILL BE DEPARTING WITH THE GROUP FROM JFK:_______________YES______________NO

I WILL BE MAKING MY OWN AIR ARRANGEMENTS:________________

I WOULD LIKE A SINGLE ROOM FOR AN ADDITIONAL: $485.00_______________(limited available)

I AM SINGLE BUT WOULD BE WILLING TO ROOM WITH ANOTHER:___________________

I WOULD LIKE TRIP INSURANCE FOR AN ADDITIONAL $202.00__________SINGLE$ 226______________

I DECLINE TRIP INSURANCE_________________(Please initial)

ROOM TYPE:  ________TWIN (2 beds)    _____________DOUBLE (1 bed)

MEAL RESTRICTIONS:___________YES  Please describe:____________________________________________________

$500 DEPOSIT IS DUE PLUS TRIP INSURANCE

DEPOSIT PAID:___________________________CHECK NO._________________DATE PAID_________________________

CREDIT CARD NO:________________________________________________________________EXP_______________________

3 DIGIT SECURITY_______________VISA   MC    DISCOVER               4 DIGIT: AMER. EXP.__________________

CHECK ONLY FOR DEPOSIT PLEASE
Please make checks payable to: TOURS GALORE & MAIL TO
8961 LAKE DRIVE #303  CAPE CANAVERAL, FL 32920
FOR FURTHER INQUIRIES :  
info@toursgalore.net     Mary Nolan: 321 212 8182      www.toursgalore.net