RESERVATION AND REGISTRATION FORM
one form for all participants at the same address
Print this form out, fill in black pen and in all caps, make a copy for yourself, and either scan and email to: ops@avivtours.com,
or send by post to : AVIV TOURS ● 320 Earls Court, Deerfield, IL 60015
✄ ********************************************************************************
YES ! Enroll me/us on the Israel Tour dep. Mar. 05, 2010 from ________________________
(originating airport)
❐ Israel only ❐ Extended Tour
if you select the Extended Tour, please also fill out the Form Optionals
My Tour Host is:
❐Dr. Harter ❐Rev. Dromazos ❐Dr. Moss ❐Fr. Carolin ❐David Blewett
NAME/S (full names as in Passport) __________________________________________________
NO. IN PARTY _______ NICKNAME/S ________________________________________________
BUS PH.. : ( ) ______-_________ Ext.: ______ HOME PH. : ( ) ______-________________
CELL PH. : ( ) ________-____________
HOME ADDRESS (not P.O.B.)________________________________________________________ CITY__________________________________________ STATE _______ ZIP _________________
EMAIL ADDRESS ______________________________ or ________________________________
❐ I wish a single room ❐ I would share a room with _______________________________
❐ Please assign a roommate I am ❐ smoking ❐ non smoking My/Our age/s : _______
Deposit of US$ ______________, at US$ 500 per person, is enclosed. Full balance is due no later than January 5, 2010, BUT later registrations accepted if accompanied by full payment
(if space not available, funds will be promptly returned)
REMIT BALANCE
