RESERVATION FORM FOR ASIA TRIP 2010
Name: __________________________________________
Residential address: ____________________________________
________________________________________________________
Home Phone Number (with area code):
Office Phone Number (with area code):
E-mail Address:
Name and address of the Person to be contacted in case of an emergency:
Passport Number:
Issuing Authority:
Issued on:
Valid till:
Date of Birth:
ACCOMMODATIONS:
[ ] I will occupy a single room at the supplemental cost of $900
[ ] Twin bed (2 separate beds) accommodations, my roommate is:___________________
[ ] Double bed (1 large bed) accommodations, my roommate is:_______________________
AIRLINE ARRANGEMENTS
United Airlines will attempt to assign you your individual seat request.
[ ] window [ ] Aisle
Special Meal Requirements: [ ] Vegetarian [ ] Diabetic [ ] Kosher [ ] Other _______
Any other special request: