Queen of Peace Travel General Reservation Form

Queen of Peace Travel/General Reservation Application

Please fully complete the following application in order to register

for one of our many wonderful trips. You may also complete this form and mail or fax to (631-361-3682)

Reservation Made By

MEDJUGORJE - PLEASE CHOOSE YOUR DEPARTURE DATE

June 18 - June 27, 2010

July 29 - August 07, 2010

October 01 - 10, 2010

PASSENGER (s) INFORMATION (Names MUST Be Exact Match to Your Passport)

Name(s) of passengers (Last / First , Middle)	DOB (mm/dd/yy)	Passport #	Nickname
1.
2.
3.
4.

Address

Address 2

City, State, Zip Code

Country

Home Phone

Work/Cell Phone

Fax

E-Mail(s)

EMERGENCY CONTACT

Name (Relationship)

Phone

REGISTRATION OPTIONS

Land Only *

I am registering for Land Only * (arrival/departure transfers not included)

Departure City

Business Class

I would like to upgrade to Business Class for an additional $2,900 roundtrip

Accommodations

Roommate Request

Travel Insurance

I DECLINE Travel Insurance.

Travel Insurance will automatically be billed unless you decline coverage at the time of registering. ($129 -$225 premium amount based on total trip costs)

SPECIAL REQUESTS

Seat Request

Meal Request

Wheelchair Request

Other Needs

::: ADDITIONAL COMMENTS OR INFORMATION :::

PAYMENT INFORMATION for General Reservations

A $400 per person deposit is due at the time of booking. The balance of your trips costs will be due

60 days prior to departure. Please note a late booking fee of $50 will be added to reservations made with in

30 days of the departure date.

I wish to make my Instant payment from my Checking Account (Automated Clearing House)

Your Bank Routing Number
Your Account Number
Amount

I wish to make my payment via Check or Money Order. Checks made payable to: 206 Tours

Please send payments to: Queen of Peace Travel/206 Tours, 333 Marcus Blvd, Hauppauge, NY 11788

Enrollment in and/or payment for any Queen of Peace Travel/206 Tours trip or service constitutes

your unconditional acceptance of all applicable Terms & Conditions.

Initial Here to agree to all Terms & Conditions

You may also print this form, complete it and fax it to us at (631) 361-3682

*** if you experience any difficulties or errors when submitting your request you may want to try and add our website to your "trusted sites" list, as that usually fixes submission errors ***