TRAVEL REGISTRATION FORM

Transcription

1 Eco International Travel, Ruffino Rd. Houston, TX USA TRAVEL REGISTRATION FORM TOUR INFORMATION Trip Supervisor Name (if it is known) Tour Destination(s) / Pocket No School Name (If school-organized trip) City where the school is (if school organized trip) TRAVELLER INFORMATION First and Middle Name (as it appears on the passport) / Last Name (as it appears on the passport) Address-Street Name Address: City, State, Zip Code Date of Birth Gender _( ) Phone Number ADDITIONAL TRAVELLER INFORMATION (ENTER IF THE TOUR INVOLVES FOREIGN COUNTRY) Passport Number Issued by Passport Expiration Date Citizenship (US or any other country) PARENT/GUARDIAN INFORMATION (ENTER IF THE TRAVELLER IS MINOR) First Name and Middle Name / Last Name Phone Number Additional phone numbers Address-Street Name Address: City, State, Zip Code EMERGENCY CONTACT INFORMATION Emergency Contact Name and Last Name Relationship Phone Number(s) 1

2 OPTIONS I will buy travel insurance by clicking on the Travel Insurance button on I want Eco International Travel to purchase the Travel Protection Plan for me - $ 18 per day. 1 I do not wish to buy any travel insurance 2. I wish to arrange my own flights I wish to arrange my departure flight from home I wish to arrange my arrival flight to home I already have travel insurance. I wish to flight in business class Additional fees apply. I do not want to share hotel room with any tour participant - Additional fees apply. PAYMENT Service description/pocket no 16-Boston, New York Total Amount ($) $1,400 PAYMENT PLAN Full payment by check or by credit/debit card Installment Payments: Each installment is one fourth of the total balance after paying the deposit. Installment Amount (USD) Amount Due Deposit $300 At registration by October 30 th 1 st payment $300 November 10, nd payment $400 December 10, rd payment $400 January 10, 2016 PAYMENT METHOD I shall pay by check. I shall pay by credit/debit card through I shall pay by wire transfer to the Eco International Travel account. The Eco International Travel s account information is as follows: Account number (Bank of America) Routing Number Bank of America Recurring & Credit Card Payment Authorization Form If you would like to enjoy the convenience of automatic recurring billing, please complete the Credit Card information section below and sign the form. Upon approval, we will automatically charge your credit card for the amount indicated. The total 1 You are strongly encouraged to purchase travel insurance providing overage for trip cancellation, baggage delay and loss, emergency medical conditions, accident, and so forth. Please refer to complete details and various travel insurance options by clicking on the Travel Insurance button on Please note that Eco International Travel is not an insurance company/agent. It only purchases insurance related to travel and tours you are participated in, on behalf of you, from the insurance companies/agents. 2 If you do not pruchase travel insurance, you need to sign the Travel Insurance Waiver form. 2

3 charges will appear on your monthly credit card statement. You may cancel the automatic billing authorization at any time by contacting us via Traveler Information (to be completed by the traveler) Traveler name/school name/city / / address Phone_( ) Payment Information (to be completed by merchant) I authorize to automatically charge the card Listed below as specified. Destination/Pocket no / Total Amount ($) Installment Amount (USD) Amount Due Deposit $300 At registration by October 30 th 1 st payment $300 November 10, nd payment $400 December 10, rd payment $400 January 10, 2016 Credit Card Information (to be completed by the traveler or his/her parent/guardian if he/she minor) Card type Master Visa AMEX Cardholder name (as shown on the card) Card number Exp.date / Security code CCV CCV is the 3-digit number on the back of your Visa/Master card or 4-digit number on of AMEX Billing Street address City ZIP Code State Phone I want Eco International Travel charge my credit /debit card for the amount(s) indicated on the table above. I understand that additional 4% Credit/debit card fee applies for the credit/debit card payment. Full Name and Signature of the Cardholder Date 3

4 CANCELLATION AND REFUND POLICY The deposit fee is non-refundable ($300) Receipt is required for refunds. Failure to have passport and visa because of out of the traveler s control may subject to refund except for the deposit fee, if Eco International Travel is notified 135 days prior to the first scheduled flight of the tour. If you cancel your trip After December 1 st there is $600 cancellation fee. All tour fee is charged and non-refundable for the cancellation made less than 45 days prior to the first scheduled flight of the tour. I have read and sign the Terms and Conditions, Participant Release and Agreement, and I file and sign Medical Treatment Authorization Form (for minors), and Travel Insurance Waiver Form (if you do not wish to buy a travel insurance, attached herewith.) Traveler Traveler s Parent/Guardian (if the traveler is a minor) Full Name and Signature of the Participant (or Parent/Guardian for minor) Date 4

5 TRIP ITINERARY DAY 1 DAY 2 DAY 3 Arrive in Boston Check in Hotel Newbury Street Public Garden Dinner at Quincy Market Take a tour of Boston and Cambridge Harvard University Harvard Square Paul Revere House USS Constitution Museum DAY 4 DAY 5 DAY 6 in Boston Travel To New York Jacqueline Kennedy Onassis Reservoir Metropolitan Museum of Art Bow Bridge Central Park Museum of Modern Art Rockefeller Center Times Square Statue of Liberty World Trade Center St. Paul s Chapel Wall Street Brooklyn Bridge China Town New Museum of Contemp. Art SoHo Breakfast at Hostel MIT University Old North Church Bunker Hill Unv. of Massachusetts Boston Freedom Trail Old North Bridge Author s Row Orchard House or Old Manse United Nations Chrysler Building Grand Central Terminals Bryant Park New York Public Library Empire State Building Flight Back Home 5