Please complete the form below.
NOTE: All areas marked with an * is required to be filled out in order to submit. If no answer or not needed, just put NA.

Tour Name *

Tour Dates *

YYYY

Passenger 1

Full Legal Name (as per passport) *

Name Tag to Say (Known As) *

Phone *

(###)

###

####

Email *

Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

YYYY

Departure City *

Return City *

Accommodation Requirements *

Single

Twin (2 Beds)

Double (One Bed)

Flight Upgrade *

Flight reservations are confirmed in “Economy Class” for this tour. Would you be interested to know more details regarding upgraded airline services, where available?

Yes

Occupation / Type of Farming / Past or Present *

Celebrating a Special Occasion?

Yes

Type of Occasion

Passport Number

Please fax, scan, or mail a clear colour copy of the picture page of your passport to our office.

Passport Expiry

Passport Country of Issue

Emergency Contact Name *

Relationship *

Emergency Contact Phone *

(###)

###

####

Frequent Flyer Program

Frequent Flyer Program Number

Do You Require Travel Insurance? *

Yes

Special Requirements *

Any special requirements Select Holidays should be aware of?

Jackets *

This tour departure offers a light weight "Select Holidays" shell jacket. These jackets are intended to be worn on top of a sweater or similar. Therefore, we suggest that you choose a size larger than you normally wear.

If another size, please state below

Passenger 2

Full Legal Name (as per passport)

Name Tag to Say (Known As)

Email Address Same as Passenger 1?

Yes

Email (If Different)

Same Phone # as Passenger 1?

Yes

Phone (If Different)

(###)

###

####

Mailing Address Same as Passenger 1?

Yes

Mailing Address (If Different)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth

YYYY

Departure City

Return City

Accommodation Requirements

Single

Twin (2 Beds)

Double (One Bed)

Flight Upgrade

Flight reservations are confirmed in “Economy Class” for this tour. Would you be interested to know more details regarding upgraded airline services, where available?

Yes

Occupation / Type of Farming / Past or Present

Celebrating a Special Occasion?

Yes

Type of Occasion

Passport Number

Please fax, scan, or mail a clear colour copy of the picture page of your passport to our office.

Passport Expiry

Passport Country of Issue

Emergency Contact Name

Relationship

Emergency Contact Phone Number

(###)

###

####

Frequent Flyer Program

Frequent Flyer Program Number

Travel Insurance

Do you require travel insurance?

Yes

Special Requirements

Any special requirements Select Holidays should be aware of?

Jackets

This tour departure offers a light weight "Select Holidays" shell jacket. These jackets are intended to be worn on top of a sweater or similar. Therefore we suggest that you choose a size larger than you normally wear.

If another size, please state below

How Did You Hear About This Tour? *

Email Communications *

I/We wish to Receive Periodic Emails on Upcoming Tours & Relevant Information?

Yes

Terms & Conditions *

I/We have read and accept the booking terms and conditions for this tour and will not hold Select Holidays reponsible if the above information is incorrect and/or if change fees are incurred, will be at the traveler’s expense. I/We authorize Select Holidays to give the above information to the travel suppliers for immigration and document purposes.

Date *

YYYY

Thank You!

Please fax, scan, or mail a clear colour copy of the picture page of your passport to our office.

We don’t just sell travel, we DESIGN it!

Customized Tours With A Difference Since 1981

22 Eva Crescent, Lacombe, Alberta, T4L 0C9 CANADA
Toll Free: 1-800-661-4326 • Local: 403-227-3545

Email: emails@selectholidays.com

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