The Impressionists and Their Influence
The Arkansas Art Center Traveling Seminar
Escorted by Joseph Lampo
May 15-22, 2011
TRIP BOOKING FORM
Passenger 1:
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: _____________
(Attacha 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: ______________________________________________________
Passenger 2: (Spouse, Traveling Companion, Roommate)
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: ______________________________________________________
Cost of land:
$8,309.00 Per Person, Double occupancy
Non-Refundable Deposit:
$1,500.00 Per Person, Due at Booking
Final Payment
Due By: February 14, 2011
In order to confirm your reservation, we must have the following in our office:
 Non-Refundable Deposit of $1500.00 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: Teresa Grace
800-727-1960 / 501-376-4171 / 501-377-7501 fax
Please check if applicable:
___ I wish single accommodations
___ One bed in room
___ Aisle seat (air)
___ Smoking Room
___ Two beds in room
___ Window seat (air)
___ Non-Smoking Room
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 $1500.00 per person will be billed on
receipt of your booking form and the balance billed to your credit card on February 14, 2011.
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.
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 14 participants to operate.
In the event of fewer than 14 participants, the price may change and you will be notified.
PROTECT YOUR TRAVEL INVESTMENT
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 coverages. A policy describing all coverages 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)
$25,000 Medical Expense (No deductibles or daily limits)
$500,000 Emergency Medical Transportation
$1,000 Lost, Stolen or Damage Baggage & Travel Documents
$750.00 Trip Delay
$300 Baggage Delay
$10,000 Accidental Death & Dismemberment
24 Hour Emergency Hotline – Travel Guard Assistance
Age
Trip Cost Per Person
0-34
35-59
60-69
70-74
75-79
80-84
85+
_____________________________________________________________________________________
$8,001-$9,000
$ 347
$ 399
$ 614
$ 798
$ 995
$ 1336
$ 1454
$9,001-$10,000
$ 384
$ 429
$ 675
$ 880
$ 1118 $ 1498
$ 1629
$10,001-$11,000
$ 441
$ 496
$ 764
$ 978
$ 1236 $ 1656
$ 1800
$11,001-$12,000
$ 498
$ 562
$ 840
$ 1090
$ 1352 $ 1812
$ 1972
$12,001-$13,000
$ 555
$ 630
$ 910
$ 1199
$ 1470 $ 1970
$ 2154
$13,001-$14,000
$ 615
$ 698
$ 992
$ 1307
$ 1597 $ 2127
$ 2349
$14,001-$15,000
$ 676
$ 769
$ 1074
$ 1415
$ 1756 $ 2285
$ 2543
_____________________________________________________________________________________
Medical Coverage
$ 13
$ 18
$ 24
$ 32
$ 42
$ 54
$ 65
Upgrade
Above rates do not include a $7 service fee applied to each policy.
I am sending a check for my insurance.
Please put my insurance on the credit card I have provided.
RESPONSIBILITY
Frederick Poe Travel Service, Inc. d/b/a Poe Travel, and all suppliers act only as agents in all matters connected
with the making and securing of reservations for transportation, accommodations, tours, and/or other arrangements
for the clients of this agency and for various disclosed principals and contractors in the form of airlines, ship lines,
tour wholesalers, limousine services, and owners or contractors providing accommodations, transportation, and/or
other services, hereinafter referred to as "suppliers." Poe Travel shall not be responsible for default or breach of
contract or any intentional or negligent actions or omissions on part of such suppliers, which result in any loss,
damage, delay, death or injury to you or your travel companions or group members. Neither this travel agency nor
any of its representatives shall be or become liable or responsible for any loss, injury, or damage to person, property
or otherwise resulting directly or indirectly in connection with any accommodations, transportation or other
services including but not limited to terrorist activities, acts of God, dangers incident to the sea, fire, breakdown in
machinery or equipment, acts of governments or other authorities, je jure or de facto, 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 schedules, from any loss or damage resulting
from insufficient or improperly issued passports, visas or other documents. In the event it becomes necessary or
advisable for the comfort or well-being of the passengers, or for any reason whatsoever, to alter the itinerary or
arrangements, such alterations may be made without penalty to Poe Travel or the operator. Additional expenses, if
any, shall be borne by the passengers. The right is reserved to withdraw any or all tours, should conditions warrant,
also to decline to accept or retain any passengers as members of the tour. In such instances an equitable amount
will be refunded. No refund can be made for any feature of the program not used by a passenger during the
operation of the tour. The acceptance of tickets, coupons, exchange orders, receipts, and contracts, shall be deemed
to be consent to all of the foregoing. The airlines concerned are not to be held responsible for any act, omission, or
event during the time passengers are not on board their planes or conveyances. The passenger contracts in use by
the airlines concerned, when issued, shall constitute the sole contract between the airline and the purchaser of these
tours and/or passenger. Similar responsibility as noted above applies to all types of carriers, including car rental
companies. In addition, services of any IATA or ARC carrier may be used in connection with this tour.
Frederick Poe Travel Service, Inc. d/b/a Poe Travel
GroupDept/Ellison/AACFrance