Arrival date in India:*
Month
Jan
Feb
Mar
Apr
May
June
July
Aug
Sep
Oct
Nov
Dec
date
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
year
2007
2008
2009
Departure date from India:*
Month
Jan
Feb
Mar
Apr
May
June
July
Aug
Sep
Oct
Nov
Dec
date
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
year
2007
2008
2009
Room requirement:*
Single
select
no
01
02
03
04
Double
select
no
01
02
03
04
Triple
select
no
01
02
03
04
Travel Insurance Required:
Yes
Decline
Special Requests /Requirements:
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Signature:
_______________________ Date:
__________________
(If you are under 18 years of age, signature of parents or guardian is required)
Note: THE TOUR RESERVATION FORM MUST BE SIGNED AND SENT TO US WITH YOUR DEPOSIT (check or credit card authorization) AND VALID PHOTO IDENTIFICATION AND A SIGNED COPY OF OUR POLICY & AGGREMENT.
I have enclosed check
or credit card authorization form
for the full payment or a non refundable deposit of USD 300.00, for a total of USD_________________
Equinox Travel Adventures 258 East 78 Street Suite 4D New York , NY – 10021 Ph: 646 509 7562 Fax: 212 000 0000