Reservation Form

To make your reservation, please print this form, fill in your information and fax to United States . Allow 1 business day to confirm your reservation. Note, we will not charge your credit card until your reservation is fully confirmed. If you are making a Club Med reservation, please be familiar with Club Med's policies.

Name: ___________________________________________________

Email: ___________________________________________________

Mailing Address: __________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

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If we have given you a price quote, please enter the Quote Number or Agent Name here: _______________

Name of Resort: _______________________________

Destination city or island: _______________________________

Are you a memeber of Club Med?  What is your membership number?__________________________

Number people traveling: ______       Trip begin date (mm/dd/yy): ____/____/____     Number nights: _____

Traveler Names (as appearing on passports):

First Name: _____________________ Last Name: __________________ Birth Date (mm/dd/yy):  ____/____/____

First Name: _____________________ Last Name: __________________ Birth Date (mm/dd/yy):  ____/____/____

First Name: _____________________ Last Name: __________________ Birth Date (mm/dd/yy):  ____/____/____

First Name: _____________________ Last Name: __________________ Birth Date (mm/dd/yy):  ____/____/____

First Name: _____________________ Last Name: __________________ Birth Date (mm/dd/yy):  ____/____/____

Need air from this city: __________________________________ (U.S. origination only)

Special Request or Questions: ___________________________________________________________________

Credit Card Number: _______________________________________________    Expiration (mm/yy): ____/____

Name as it appears on card__________________________________________

Signature:________________________________________________________

I authorize travel charge on my card, as agreed, for $________________ (US dollars)

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