Neovoyage

Photography Tour Reservation Form

Destination Ecuador (Andes)
Tour Dates TBD
Price $3950 USD per person based on double occupancy
$800 USD per person single supplement
Deposit $600 USD per person due along with signed reservation form
Balance Due by ,
Itinerary http://www.neovoyage.com/tour.php?dest=ecuador-andes
Terms http://www.neovoyage.com/terms.php
Info info@neovoyage.com

PLEASE FILL OUT COMPLETELY AND LEGIBLY

Payee Contact Information

Name: _________________________________

Street and civic number: _____________________

City: ___________________________________

State or Province: _________________________

Zip or postal code: ________________________

Country: _______________________________

Day phone number: _______________________

Evening phone number: ____________________

Email address: ___________________________


Emergency Contact Information

Name: _________________________________

Relationship:_____________________________

Street and civic number: _____________________

City: ___________________________________

State or Province: _________________________

Zip or postal code: ________________________

Country: _______________________________

Phone number: __________________________

Email address: ___________________________

Total Number of spaces requested: ____________

If the number of passengers is odd, check one:

(____) Requesting single accommodation. Will pay the single supplement, unless such accommodations are not available.

(____) Requesting a roommate. If no suitable roommate is found, will pay single supplement.

If requesting a roommate, circle details of passenger requesting a roommate:

(M) / (F) - (Non-Smoker) / (Smoker)

Passport Information For All Participants

Full Name
(As in Passport)
Passport Number

Expiry
(M/D/Y)

Country
Of Issue
Date of Birth
(M/D/Y)
         
         
         
         
         
         
         
         
         
         
         

By signing below:
- I agree with the Neovoyage terms of service.
- I agree to pay the balance by two months (60 days) before the scheduled tour date.
- I certify that all information here is accurate and legible.

Signature: ______________________________________________________

Include a check, banker's check or money order in the amount of $600 USD per person for deposit.
Mail completed form and check to:

Neovoyage @ Cybernium
2397 Chopin
LaSalle, QC
Canada, H8N 2H7