Reservation Form

 

 

 

Home Trip List Photo Album Studebaker 2012 Reservation Form Travel Insurance Miscellaneous Deposits Inbound Groups


Trip Name___________________________________ Trip  Date_________________

Name_____________________________ Street______________________________

City/State/Zip_____________________________________ Birth Date ___________

Phone No. __________________________  Cell No. ___________________________

Email _______________________________________  Amount Enclosed __________

Traveling Companion______________________________ Birth Date______________

Street___________________________ City/State/Zip_________________________

Phone No. _________________________Cell No. _____________________________

Email Address___________________________________________________________

Smoking___                  Non-Smoking____                 (Will request - No guarantee)

Accommodations:       1 bed______       2 beds______

First name(s) you want on nametag(s)_______________________________________

Emergency Contact Name & Phone__________________________________________

Doctor's Name, address & phone number______________________________________

List of medications _______________________________________________________

Special Dietary Needs ____________________________________________________

I will load the motor coach in:

Elkhart____       South Bend South____       South Bend North ___       LaPorte ___

___ I am aware that I may purchase trip cancellation insurance through a travel insurance provider.

__________________________________________________________
Signature                                                               Date