Passenger Name ___________________________________________________________________________________________________________________________________
Date of Birth _________/___________/___________
Name must match exactly with passport or name change fee will be imposed by the airline. If you do not yet have your passport check here □
Mailing Address ___________________________________________________________________________________________________________________________________
City / State / Zip_________________________________________________________________________
I wish to reserve:
[ ] Land & Air $3,295.00 (includes airline tax*) or [ ] Land-Only $2,895.00 *airline taxes are subject to change until ticketed
[ ] Insurance $209.00 ( Insurance can only be purchased with deposit )
Room Type: [ ] Twin (2 Beds) [ ] Double (1 Bed) [ ] Single (Single Supplement $375.00) Sharing with: __________________________________________________________________________
[ ] Check enclosed (payable to NACTA Travel)
[ ] Please charge my credit card. Card # ___________________________________________________________________________________________________________
Exp __________/____________ Security Code __________________
[ ] Payment Amount $_________________
Deposit of $250 is required to reserve your place on the tour. Deposit is 100% refundable if you cancel prior to December 23rd, 2017.
Payment in full is due by February 1st, 2018. Make checks payable to NACTA Travel.
Complete this form and return with payment of $250 per person, or $459 if you wish to purchase travel insurance (recommended).
Mail to: NACTA Travel, 93 W 55 Street Bayonne, NJ 07002 or call us at 866-622-2244 or email email@example.com