CUBA BEYOND THE BEACHES & DREAMCATCHER WORKSHOPS

Box 2345, Swan River, MB R0L 1Z0 - Phone (204) 525-4396

(REGISTRATION FORM)

Print this form on standard 8½ x 11 paper (portrait orientation) and fax with your payment to the number below.

If you are unable to scan this form and send it electronically – please fax it to (204) 525-2068

One Form Per Participant

Tour / Workshop Name:
Departure Date:
Name (as on passport):
Address:
City:	Prov. / State:
Postal Code / Zip:	E-Mail:
Phone (Home):	Phone (Work):
Phone (Cell.):	Phone (Fax):
I require:	o Cancellation / Trip Insurance o Medical Coverage Package o Both
I do not wish to take insurance (signature required):
I have a special medical / dietary condition:
I will be sharing a room with:
I am a single traveler and I prefer a:		o Roommate o Private Room
City, Country of Birth:
Date of Birth (month, day, year):
I have a valid passport:		o Yes o No
Country of Issue:
My passport number is:
Expiry date (month, day, year):
I, the undersigned, have read, understand and agree to the Booking Procedures and Conditions (See Pre-Tour Information on website) Deposit of 50% of tour is required at time of booking for all tours. Some payments may be required in entirety at time of booking. Balance due 60 days prior to tour. $800.00 Canadian required at time of booking for all special and private tours. (Non refundable unless tour cancelled by Cuba Beyond the Beaches)
My payment is by:	o Credit Card (additional fee of 3% applies) – We will forward an authorization form (for limited services only). o Wire Transfer – We will forward wire transfer information. o Cheque – Canadian banks only - please allow 15 days for clearance on Canadian cheques.
I am authorizing:	o Deposit or o Full payment for person(s)
Credit Card Type:	o VISA o MasterCard
Credit Card #:	Expiry Date (month, year):
Signed:	Date: