nature tours & travel, wildlife tours, adventure travel and general travel to Australia, Southeast Asia, South America and Alaska

 

 

VIETNAM & CAMBODIA - DISCOVERING THE MEKONG AND THE TEMPLES OF ANGKOR

RESERVATION FORM

Please confirm your cabin by phone on 1 877 285 1170. Enclose an $800 per-person deposit to secure your space(s) to reach us within one week of confirmation. Checks should be made out to Nature Travel Specialists Trust Account. Deposits may be made by personal check or credit card; the latter can be called in by phone on 1 877 285 1170. If you do not have a current (6 months beyond return date) passport please call or email us. A PDF of this form can be downloaded by clicking here.

Departure Date: September 8, 2010

Name(s) Dr/Mr/Mrs/Ms ______________________________________________________________________
(Please print full name as it will appear on your passport at time of travel; if preferred name differs please enclose this in brackets after passport name)

___________________________________________________________________________________________

Address: ___________________________________________________________________________________

City/State/Zip _____________________________________________________________________________

Home Phone __________________________ Day phone ___________________ Mobile ___________________
(please include number where you can be reached prior to departure)

Email: _____________________________________________________________________________________

Please read and sign (each participant/legal guardian must sign):
I have received, read and accept the conditions of the General Information section, especially the Cancellation and Responsibilities Terms and Conditions paragraphs. I would like to make reservations for the person(s) listed above with the enclosed deposit.

Date:___________________Signature(s)__________________________________________________________

___________________________________________________________________________________________

KEP EXTENSION        YES         NO        (please circle)

PASSPORT INFORMATION

Please use block capitals and ensure that all travelers’ details are completed. In addition to the written information below, please enclose a photocopy of the information page of your passport.

Name_______________________________________________________________________________________________________

Country of Birth_______________________________________ Passport Number _______________________________________

Issuing Country _______________________________________ Place Issued ___________________________________________

Expiry Date __________________________________________ Date of Birth______________________ Sex (please circle) M F

Name_______________________________________________________________________________________________________

Country of Birth_______________________________________ Passport Number _______________________________________

Issuing Country _______________________________________ Place Issued ___________________________________________

Expiry Date __________________________________________ Date of Birth______________________ Sex (please circle) M F

Name_______________________________________________________________________________________________________

Country of Birth_______________________________________ Passport Number _______________________________________

Issuing Country _______________________________________ Place Issued ___________________________________________

Expiry Date __________________________________________ Date of Birth______________________ Sex (please circle) M F

Name_______________________________________________________________________________________________________

Country of Birth_______________________________________ Passport Number _______________________________________

Issuing Country _______________________________________ Place Issued ___________________________________________

Expiry Date __________________________________________ Date of Birth______________________ Sex (please circle) M F

Name_______________________________________________________________________________________________________

Country of Birth_______________________________________ Passport Number _______________________________________

Issuing Country _______________________________________ Place Issued ___________________________________________

Expiry Date __________________________________________ Date of Birth______________________ Sex (please circle) M F

Frequent Flyer Numbers:

Name: ____________________________________________________ Airline: ____________ FF #: ________________________

Name: ____________________________________________________ Airline: ____________ FF #: ________________________

Name: ____________________________________________________ Airline: ____________ FF #: ________________________

Name: ____________________________________________________ Airline: ____________ FF #: ________________________

Name: ____________________________________________________ Airline: _____________ FF #: ________________________