|
TITLE
|
FIRST NAME - EXACTLY AS SHOWN ON PASSPORT
|
NAME YOU WISH TO BE KNOWN BY
|
SURNAME
|
DATE OF BIRTH
|
TICK IF SINGLE SUPPLEMENT REQUIRED
|
|
1
|
.
|
.
|
.
|
.
|
.
|
|
2
|
.
|
.
|
.
|
.
|
.
|
|
3
|
.
|
.
|
.
|
.
|
.
|
|
4
|
.
|
.
|
.
|
.
|
.
|
|
NATIONALITY
|
PASSPORT NUMBER
|
NAME: | |
|
1
|
.
|
.
|
ADDRESS: |
|
2
|
.
|
.
|
|
|
3
|
.
|
.
|
|
| POSTCODE: | |||
| TELEPHONE (DAY): | |||
| TELEPHONE (EVENING): | |||
| E-MAIL ADDRESS: |
|
HOLIDAY DESTINATION
|
DATE COMMENCING
|
DATE RETURNING
|
DEPARTURE AIRPORT
|
|
|
.
|
.
|
.
|
|
SPECIAL REQUIREMENTS (E.G. VEGETARIAN) |
Details of Insurance cover are included in the brochure. Unless you enter 'NO' on the following line and give details of your insurance company, insurance will be issued for you.
___________________________________________________________________________________________________
I enclose a cheque/money order Payable to BIRD HOLIDAYS LTD for £ ........................being the deposit (& insurance premium)
for ...…........ persons. For details of deposit and insurance please refer to the end of each holiday write-up. If you wish to pay by credit card please give details overleaf (cardholder's name, card number, expiry date, type of card).
Name, address and phone number of next of kin (not travelling)
________________________________________________________________________________________________________
Does any member of the party have a medical condition which we should be aware of (eg. diabetes, epilepsy etc.)? Yes / No.
If 'yes' please give details overleaf.
I have read the conditions of booking and insurance and confirm that I am authorised to accept them on behalf of all the above named persons.
Signature of first named person ________________________________________________ Date ____________________________
Please return completed booking form to: BIRD HOLIDAYS, 10, IVEGATE, YEADON, LEEDS, LS19 7RE