You may also download the PDF version below , print out this page, sign it and fax it to N° (519) 753-6376 or to send it by post to:
PAUWELS TRAVEL BUREAU LTD., 95 Dalhousie Street, Brantford, Ontario N3T 2J1 - Canada

I WOULD LIKE TO BOOK THE FOLLOWING TOUR : 

Number of seat(s): Departing:

Enclosed is my/our deposit of  ($750 CAD per person, plus insurance premium if taken). Deposit and insurance premium, if taken, are due with registration. You will be invoiced for the balance approximately 45 days prior to departure.

WE NOW REQUIRE A COPY OF YOUR PASSPORT - VALID FOR 6 MONTHS AFTER RETURN - TO BE SENT WITH YOUR APPLICATION FORM AT TIME OF REGISTRATION.

Name as it appears on passport. Indicate the appropriate title before each name (Mr., Mrs., Miss, Dr., Ms.):

traveller 1
traveller 2


If applicable, give your commonly used first name as you would like it to appear on your name tag: (e.g. “Liz” for “Mary Elizabeth”):

traveller 1
traveller 2
   
E-MAIL:
ADDRESS: City, Prov., P.C
PHONE:  (Residence) (Business) FAX: 
   
If traveling alone, please indicate your willingness to share accommodations:
YES
NO
SINGLE ROOM REQUIRED
(We will try to find a roommate for those willing to share, but cannot guarantee success in doing so. For single travelers we are not able to match, the single supplement will apply.)
SPECIAL REQUESTS: (Dietary, wheelchair assistance, frequent flyer number, twin beds, etc.): Please list here so we can do our best to assist you:so we can do our best to assist you:
I/we agree to the “terms and conditions” attached to the program.
Insurance, I/we accept:
All-inclusive Package $
Non-medical Package   $
Decline Insurance
If purchasing travel insurance, we will require your date of birth:

Name of birth: Date of Birth:

Name of birth : Date of Birth:

PAYMENT:

Cheque payable to Pauwels Travel    Visa      American Express      Mastercard

Please, call the office once you have submitted your application online and provide us with the credit card information over the phone.



PAUWELS TRAVEL BUREAU LTD. -- SHIP'S SCHOOL EDUCATIONAL TOURS 
95 Dalhousie Street, Brantford, Ont. N3T 2J1
Tel. (519) 756-4900 - Fax (519) 753-6376
E-mail:  tours@pauwelstravel.com

 

  
 
  
  

PAUWELS TRAVEL BUREAU LTD. -- SHIP'S SCHOOL EDUCATIONAL TOURS