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BIRD TREKS REGISTRATION FORM
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Airfare is payable by credit card.
We can accept only a check or money order for the deposit and tour fee.
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I/We wish to register for the following tour:
TOUR NAME: __________________________________________________________________________
TOUR DEPARTURE DATE: ________________________ TODAY'S DATE __________________________
DEPOSIT ENCLOSED (check or money order only): $_____________ for ______ person(s).
Balance is due at least 60 days prior to departure date.
NAME(S): ________________________________________________________________ sex _______
_________________________________________________________________________ sex _______
ADDRESS: ____________________________________________________________________________
TOWN: ___________________________________________ STATE: ________ ZIP+4: ____________
PHONE: Home (___)______________ Business (___)______________ Cell (___)______________
EMAIL ADDRESS _______________________________________________________________________
___ I wish to have a single room, wherever possible, at additional cost.
___ I have a roommate (name): _______________________________________________________
___ I wish BIRD TREKS to provide a roommate, but if none is available, I understand there will be no extra charge.
I am a ____ non-smoker ____ smoker
Please list ALL health problems or special dietary needs:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
In case of emergency, notify:
(Name)________________________________________________ (Relation)____________________
(Phone)____________________________________________________
For any international tour, including Canada and Mexico, we need your:
Passport #___________________________________________ Country Issued ________________
Your Complete Name as it is on Passport _____________________________________________
I wish BIRD TREKS to handle my flight arrangements:
____ yes ____ no ____ only after my approval
If yes or with approval, please complete the following information:
Preferred Departure City/Airport ____________________________________________________
Alternate Departure City/Airport ____________________________________________________
Departure Date _____________________________ Return Date ____________________________
Preferred Airline(s) ________________________________________________________________
Frequent Flyer Number(s) ____________________________________________________________
Seating Preference (please circle):
Economy ________
First Class __________
Window _________
Aisle ______________
Senior Citizen (62 years or older): _____ yes _____ no
Preferred Payment of Airfare (circle one):
Check Money Order Credit Card: AmEx MC Visa
Card # _______________________________________ Expiration Date: _____________________
Name as it appears on the card: ________________________________________________
Please read the Release Form,
sign, date and return with your deposit check/money order to:
BIRD TREKS, 216 Spring Lane, Peach Bottom, PA USA 17563-4008
Phone 717-548-3303 ~ Fax 717-548-3327 ~ info@birdtreks.com
We can accept a credit card for airfare, but require a CHECK OR MONEY ORDER for the tour fee.