mdtravel.ca 22nd. Annual Spring Conference,
Costa Rica - 9 - 16 February 2012
!. Name, as on passport
Date of birth dd/mm/yy
2. Name, as on passport
Date of birth. dd/mm/yy
Home Address
BOOKING FORM
Home Tel.
Office Address
Email.
Office Tel
Office Fax
$500 deposit per person, balance will be billed to your account on 22 December 2011. Conference and spousal program fee billed just before departure.
Credit Card Visa/ Mastercard
Number
Exp.
Name on Card:
Signature
TRAVEL INSURANCE (Recommended)
Yes
No
Medical Insurance.
CONFERENCE REGISTRATION.
1. Name on Tag.
2. Name on Tag.
I would be willing to make a short presentation.
Yes
No.
Payments are made to a Registered Travel Agent, Uniglobe Voyageur Travel, Newmarket.
For further travel information, please call Jill Nunn of Uniglobe 905 895 2433
You may complete this form on line, and press the "Submit" button, or
Print this form and fax to : 905 895 4509
Yes
No
