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Click here for printer friendly version

Please print this form and the Liability Waiver (Printer Friendly version), complete, and mail  to us.

If you have any questions, please contact us

 

REGISTRATION FORM

TOUR NAME:

YOUR FULL NAME(S):

ADDRESS:

PHONE:

E-MAIL:

EMERGENCY CONTACT:

            NAME:

            RELATIONSHIP:

            PHONE#:

ACCOMMODATION:

            ---- DOUBLE OCCUPANCY.
                 
I plan to share a room with  .

                        Bed Preference
                        ____ Double Bed         ____ Twin Beds 

            ---- I NEED A ROOM PARTNER. If a partner is not available the Single
                      Occupancy Supplement will be applicable.

            ---- SINGLE OCCUPANCY. The Single Occupancy Supplement is
                      applicable.

 

MEDICAL INFORMATION:

            Do you have any medical condition that might restrict your participation in the tour, or that the tour leader should be aware of for your safety, or in the event of an emergency? For example: mobility problems, diabetes, heart conditions, etc.

Please provide any relevant details on a separate sheet.

 

Signature:                                                                               Date:

 

 

For more information or to reserve your space:

click here to email

phone: 604 885-5539

Box 319,  Sechelt, British Columbia, V0N 3A0, Canada

 

 Click on photo for information about the tour.


Updated March 30, 2010

Send mail to tony@whiskeyjacknaturetours.com with questions or comments about this web site.
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