HAMDEN ROTARY CLUB TOURS
INTERNATIONAL CONVENTION REGISTRATION FORM

Please complete form and either email, mail or fax with check or credit card information.
Please print completed form.

Hamden Rotary Club Tours
111 Township Line Road
Jenkintown, PA 19046 USA
Telephone: 800-223-3863 x 1111 Fax: 215-379-6834

Enclosed is my deposit of US $1000 per person. I understand that the tour price includes all hotel accommodations including a Bangkok, Thailand Convention hotel, Rotary International Convention registration fee, all group transfers, hotel taxes, baggage handling, guides, meals, cocktail reception as indicated in each itinerary, and all sightseeing and professional tour escorts. All rates are quoted as double occupancy (2 people to a room). Single reservations require a supplement as listed. All payments must be made in United States dollars.

 

Cancellation Insurance

I understand that there are cancellation penalties associated with this tour as outlined in the Term & Conditions.

Hamden Rotary Club Tours and TLG Travel recommend that each participant purchase cancellation protection insurance.

The cost for insurance coverage will be provided as part of your Welcome Packet upon processing your registration.

Please Check One of the Following Boxes and Sign Below


   
Please Complete the Following Boxes
TOUR CHOICE :
 
BANGKOK HOTEL CHOICE
DEPARTURE AIRPORT PREFERENCE:
1.
2.
 
Traveler Number 1: Please Complete the Following Boxes
Full Name:
   
(Full legal name as it appears on passport -no nicknames)
Use of any name other than legal name will result in airline change penalties.
Badge Name:
 
Birth Date:
 
Primary Address:
 
City:
 
State or Country:
 
Postal Code:
 
Rotary District:
 
Day Time Telephone Number :
   
Include Country & City Code if applicable.
Cell Phone Number :
Email Address:
   
Rotary Club Name:
 
Rotary Classification:
 
Rotary Office 2012-2013:
 
DG Year:
 
   
Traveler Number 2: Please Complete the Following Boxes
Full Name:
 
(Full legal name as it appears on passport -no nicknames)
Use of any name other than legal name will result in airline change penalties.
Badge Name:
 
Birth Date:
 
Primary Address:
 
City:
 
State or Country:
 
Postal Code:
 
Day Time Telephone Number :
 
Include Country & City Code if applicable.
Cell Phone Number :
Email Address:
 
Rotary District:
 
Rotary Club Name:
 
Rotary Classification:
 
Rotary Office 2012-2013:
 
DG Year:
 
Billing Information
Total Amount Enclosed:
 
Or / Charge my Master Card or Visa:
 
Expiration Date:
 
Security code
   
Name as it appears on Credit Card:
Check the box if Credit Card Address is the same as above.
Credit Card Address
City:
State or Country:
Postal
   
   
Signature:
_________________________________________________
   
How did you hear about us?
 
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