Provence & French Riviera
with
Robin Parker and Anthony Bay
April 23 – May 2, 2013
TRIP BOOKING FORM
I authorize Poe Travel to begin the booking process for my trip with the information below. Date: __________
Name: ____________________________________________________________________________________
(As appears on your valid passport…passport must be valid at least 6 months beyond last travel date.)
Passport Number __________________ Issue Date: _____________ Expiration Date: _________________
(Attach a readable copy of your passport – the page with your picture on it)
Birth Date: ___________________________________________________________________ (mo/day/year)
Address: __________________________________________________________________________________
City, State, Zip: ____________________________________________________________________________
(Address for billing of final payment)
Daytime Phone: ____________________________ Evening Phone: _________________________________
Email Address: ____________________________________________________________________________
Emergency Contact: ________________________ Phone Number: _________________________________
Emergency Contact Email Address: ___________________________________________________________
Frequent Flyer # ____________________ Airline _______________Password or Pin __________________
Frequent Flyer # ____________________ Airline ______________Password or Pin __________________
Traveling Companion Information
Name: ___________________________________________________________________________________
(As appears on your valid passport…passport must be valid at least 6 months beyond last travel date.)
Passport Number __________________ Issue Date: _____________ Expiration Date: _________________
(Attach a readable copy of your passport – the page with your picture on it)
Birth Date: ___________________________________________________________________ (mo/day/year)
Address: __________________________________________________________________________________
City, State, Zip: ____________________________________________________________________________
(Address for billing of final payment)
Daytime Phone: ____________________________ Evening Phone: _________________________________
Email Address: ____________________________________________________________________________
Emergency Contact: ________________________ Phone Number: _________________________________
Emergency Contact Email Address: ___________________________________________________________
Frequent Flyer # ____________________ Airline _______________Password or Pin __________________
Frequent Flyer # ____________________ Airline _______________Password or Pin __________________
Pricing
Cost of land arrangements:
Single Rate:
Insurance:
Non-Refundable Deposit:
Final Payment
$4,972.00 Per Person, Double Occupancy
Available Upon Request
Please check with Poe Travel for Insurance Rate
Non-refundable deposit of $500.00 due immediately
Due March 23, 2013
Price Inclusions:
 Four nights’ accommodation at the Hotel de l’Image, St Rémy de Provence in a Twin Horizon Terrace
Suite with breakfast, local taxes and porters’ tips included.
 Five nights’ accommodation at the Hotel Welcome, Hotel Welcome, Villefranche sur Mer, French
Riviera, in double superior room with balcony and front sea view, breakfast and taxes.
 Services of Anthony Bay as a Guide from arrival at Marseilles airport on Tuesday 23rd April until end of
day Monday 1st May
 Airport transfers on 23 April and 02 May
 Minibus travel in the St Rémy area and another on the Riviera as well as water provided on the minibus
 Entrance to Glanum, van Gogh asylum, Carrieères de Lumière, Picasso Museum, Matisse Museum,
Chagall Museum, Maeght Foundation, Matisse Chapel and Villa Rothschild
 Private guided visit of the Abbey of Sénanque, and a private visit of the Chateau d’Estoublon with wine
and olive oil tasting
 Private visit of the art collection at La Colombe d’Or with glass of wine or equivalent
 Tasting of local specialities in Nice food market and at the Nice olive merchant
Reservation Confirmation
In order to confirm your reservation, we must have the following in our office:
 Non-Refundable Deposit of $500.00 per person
 Completed and signed booking form
 Copy of picture page of passport
Please send or deliver your deposit, booking form and copy of your passport to:
Poe Travel, P.O. Box 2576, Little Rock, AR. 72203
ATTN: Nancy O’Brien
TF (800) 727-1960
T (501) 376-4171
F (501) 377-7501
Please check if applicable:
___ I wish single accommodations where offered
___ Aisle seat (air)
___ Smoking Room
___ Two beds in room
___ Window seat (air)
___ Non-Smoking Room
Credit Card Information
If you wish to pay for your travel with a credit card please list your name as it appears on the card, the card number,
expiration date and billing address. Note: the non-refundable deposit of $500.00 per person will be billed on
receipt of your booking form and the balance billed to your credit card on March 23, 2013.
I authorize Poe Travel to charge my credit card payments for the above mentioned trips.
There is a 3.5% fee for processing credit card payments.
Place your credit card underneath this form in the above box. Use a #2 pencil to trace the numbers and name inside the box.
Credit Card and number: _______________________________________
Exp. Date _______________
Name as it Appears on Card: ___________________________________
CID # ___________________
Billing Address: ____________________________________________________________________________
____________________________________________________________________________
PLEASE SIGN THE FOLLOWING STATEMENT REGARDLESS OF PAYMENT CHOICE.
I accept the terms of the attached brochure and have read and understand the conditions outlined in the cancellation and
responsibility clauses.
Signature: _____________________________________________________________ Date: ____________________________
IMPORTANT NOTE
This tour must have at least 12 participants to operate.
In the event of fewer than 12 participants, the price may change and you will be notified.
Client Travel Agreement
Frederick
Poe
Travel
Services,
Inc.
d/b/a
Poe
Travel
(“Poe
Travel”)
and
______________________________ “Client”, enter into this Client Travel Agreement in connection with Client’s
proposed travel, more fully described on Client’s Proposal For Travel.
1.
Client agrees to be fully responsible for all costs and charges associated with the travel referenced
in the Proposal For Travel. Client acknowledges receipt and approval of the Proposal For Travel. If Client requests
and/or approves changes to the Proposal For Travel, Client agrees to remain responsible for all costs and charges
associated with all changes.
2.
In addition to paying for all costs and charges associated with Client’s travel, Client agrees to pay
Poe Travel all fees reflected on Poe Travel’s Fee Sheet. Client acknowledges receipt and approval of the Fee Sheet.
3.
Client agrees to complete and return to Poe Travel the Trip Booking Form. Client understands that
no final travel documents will be delivered to Client until the Trip Booking Form has been completed and return to
Poe Travel.
4.
Client understands that Poe Travel is acting as Client’s agent in making arrangements for the travel
reflected on the Proposal For Travel, including but not limited to, travel with all airlines, ship lines, tour
wholesalers, limousine services, bus companies, transportation companies and owners or contractors providing
accommodations, food, tours, transportation and all other travel related services, hereinafter referred to as
“suppliers”.
5.
Client agrees that Poe Travel will not be responsible for any default or breach of contract or any
intentional or negligent actions or omissions on part of any suppliers, which result in any loss, disruption, damage,
delay, death or injury to client or any of client’s travel companions or group members. Poe Travel shall not be
liable or responsible for any of Client’s loss, injury or damage to person, property or otherwise, including but not
limited to, terrorist activities, acts of God, weather, dangers incident to the sea, fire, breakdown of machinery or
equipment, acts of government or other authorities, wars, whether declared or not, hostilities, civil disturbances,
strikes, riots, thefts, pilferage, epidemics, quarantines, medical or customs regulations, defaults, delays or
cancellations of or changes in itinerary, routing or scheduling, or from any loss or damage resulting from
insufficient or improperly issued passports, visas or other documents. Client agrees that Poe Travel will not be
responsible for any failure of a supplier to provide to Client any of the travel related services reflected on the
Proposal For Travel or any amended Proposal For Travel.
6.
If, in the judgment of Poe Travel, it becomes necessary or advisable for the comfort or well-being
of the Client to alter the Client’s itinerary or arrangements, such alterations may be made without penalty or
liability to Poe Travel. If the alterations result in any additional expenses, Poe Travel will obtain the Client’s
approval for those additional expenses. Client agrees to be responsible for all additional expenses approved.
7.
If Client’s trip is part of a Poe Travel guided tour, Poe Travel reserves the right to withdraw any or
all tours if, in Poe Travel’s sole discretion, conditions warrant, and Poe Travel reserves the right to decline to accept
or retain any individual as a member of the tour. If a Poe Travel guided tour is withdrawn, or if an individual is not
retained as a member of the tour, an equitable amount will be refunded to the Client. No refund will be made for
any feature of a Poe Travel guided tour not used by the Client during the operation of the tour.
8.
If a dispute arises between Poe Travel and Client stemming from or related to this Client Travel
Agreement, the travel reflected on the Proposal For Travel or from any service provided by Poe Travel to the
Client, the parties agree that any dispute shall be governed by Arkansas law and shall be subject to the exclusive
jurisdiction of the federal courts in the Eastern District of Arkansas, Western Division or in the Arkansas circuit
courts in Pulaski County, Arkansas. The choice of forum is intended by the parties to be mandatory and not
permissive, thereby precluding the possibility of litigation between the parties in any jurisdiction other than the
federal courts in the Eastern District of Arkansas, Western Division or in the Arkansas circuit courts in Pulaski
County, Arkansas. Each party waives any right it, he or she may have to assert the doctrine of forum non
conveniens or similar doctrine or to object to venue with respect to any proceeding brought in accordance with this
provision.
Client: ________________________________________________________________ Date: __________________
Travel Insurance
Travel Guard International
Poe Travel regards travel protection to be important, meriting your review. Travel Guard International (TGI) is
available to residents of the United States and Canada. TGI provides coverage not available through your health,
homeowner’s, or credit card insurance.
Below is a brief description of coverage offered. A policy describing coverage in detail will be mailed to you by
TGI.
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No Age Limit
Pre-Existing Condition Coverage –
(Must purchase policy within 21 days of your initial trip payment or deposit)
Trip Cost Trip Cancellation & Interruption
The amount of the Trip Cancellation coverage purchased must equal the full cost of all trip arrangements,
excluding service due to Poe Travel.
Trip Cost Default Protection
(Protection against the financial default of cruise lines, airlines and tour operators)
Medical Expense (No deductibles or daily limits)
Emergency Medical Transportation
Lost, Stolen or Damaged Baggage & Travel Documents
Trip Delay
Baggage Delay
Accidental Death & Dismemberment
24 Hour Emergency Hotline – Travel Guard Assistance
The cost of insurance is in addition to the trip rate.