Going Places Together "yes" form

YES, I WANT TO VISIT _________________WITH

GOING PLACES TOGETHER

1...Print out this page.
2...Add your cheque, payable to: Uniglobe Creative Travel Inc.
3...Then mail it to: Nancy, Going Places Together
197 Douro Street, Stratford, On. Canada, N5A 3R8

NAME:__________________________________________, Date of Birth:________________________
name as it appears or will appear on your passport

ADDRESS:_________________________________________ __________________________________

ADDRESS:________________________________ ________ POSTAL CODE (ZIP)_______________

TELEPHONE #________________________ EMAIL address__________________________________

I AM ENCLOSING MY NON-REFUNDABLE DEPOSIT...in event that I (particpant) cancel.

It is highly recommended that your purchase cancellation insurance and out of country medical.

IN THE AMOUNT OF :

__$500.00 Painting Portugal (Payment for this tour is by cheque or cash only) All cheques must be payable to
Uniglobe Creative Travel and sent with this form to Going Places Together at the above address

__$500.00 The Best of Australia

__$500.00 Japan and South Korea

SIGNED:_______________________________________________

If you wish to use a credit card

Credit Card number:_______________________________

Name on Card:____________________________________

Date of exp:_____________________________________PAY BY CASH OR CHEQUE AND SAVE 3%


TICO # 50006797

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