Poultry Tour 2006 Application

Poultry Fanciers Tour
October 12-23, 2006
$2619 per person/double occupancy * $325 Single Supplement
A $600.00 per person deposit by Dec. 20th, must accompany this reservation to guarantee your spot on the tour.
Final payment is due no later than August 3, 2006.
Questions? Call Jennifer Turner at 800-486-0860 or email jturner@brookfieldtravel.com.
Please return this signed form along with your deposit to: Brookfield Travel Group Department,
attn. Jennifer Turner, 19045 West Capitol Drive, Suite 100, Brookfield, WI 53045

Name: _______________________________________________________________

Name MUST appear as it is on your passport. Including middle name.

Phone: Work (__)___________________ Home (__)_____________________

Address: _________________________________________________________

City_______________________________________State____Zip___________

E-Mail Address_____________________________________________________

Passport Number(s) Expiration date(s):___________________________________________

Deposit of ($600 X ____ person(s) = $_______ is enclosed in check form, make check payable to Brookfield Travel.

If you prefer to pay by credit card, you will no longer be eligible for the cash discount and the revised
tour price is $2750.

To pay by credit card:

I authorize Brookfield Travel to charge the credit card below for the deposit now ($513)
and final payment on August 3, 2006.

American Express / MasterCard / Visa / Discover

Account Number: _______________________________Expiration Date: __________

Name__________________________________ __________________________________
Name as it appears on Card Authorizing Signature

I will share a room with: ______________________________________________________
Airline Seat request: Aisle____ Window ____ Special Meal Requests: ____________
Name(s) for Name Tag: ____________________________
I prefer a single room at $325 supplement (limited number) __________
I am looking for a roommate __________
Please send me information on trip cancellation protection insurance __________
I decline trip cancellation insurance and understand that I assume all risks of trip cancellation __________
I have thoroughly read the terms and conditions listed above and agree to abide by the stated cancellation,
deposit and payment policies. I/we understand that all travelers must sign and date this form.

Signature(s)_______________________________________Date________________
Emergency Contact ______________________________Phone__________________
Relationship_____________________________

Air Taxes & Gratuities will be invoiced with the final payment (estimate $260).