*Please print name as it appears on your PASSPORT. No nicknames.
PASSENGER NAME(S): _________________________________________________________________________
ADDRESS: ________________________________________ CITY/STATE/ZIP ______________________________
PHONE: (DAY) _______________ (EVENING) ______________ EMAIL ADDRESS: _________________________
ROOMMATE(S) __________________________________________________________ SINGLE ( )
INSURANCE FORM REQUEST: ____ YES (To be covered for financial default and pre-existing condition insurance must be purchased within 14 days of the initial trip deposit. Please read insurance policy thoroughly for exclusions and exceptions).
____ NO (Please read insurance form thoroughly before answering no. Insurance covers more than just cancellations). I understand that I am not obligated to purchase travel insurance, but realize I will not receive any refund of my tour package or policy premium in the event I must cancel my trip after the penalty period. This includes for reasons of illness, death, as well as, any other purpose of my cancellation.
EMERGENCY CONTACT____________________________________________PHONE_________________
CABIN CATEGORY SELECTION: (B) ___ (A) ____ TWIN BED ______ QUEEN BED _____
CELEBRATING AN ANNIVERSARY OR BIRTHDAY?: _______________________________________
ANY SPECIAL DIETARY NEEDS OR REQUESTS?: ________________________________________________
SIGNATURE(S): _________________________________________________________DATE______________
By signing I am agreeing to the terms and conditions of the tour. Signed reservation form must be accompanied with deposit.
(Free payment plan available. Payments are due in the form of a check.)
Make all checks payable to: “Legacy Tours” Mail to: 2223 W Gordon Street, Allentown, PA 18104