HOTEL & TRANSPORTATION RESERVATION FORM
WJA Member Name:
If Traveling with, Companion Name:
WJA Registration Date:
Address:
City:
State:
Postal Code:
Country:
Home Phone:
Home Fax:
Office Phone:
Office Fax:
Email Address:
Contact Person While Traveling:
Phone:
Email:
PASSPORT INFORMATION ( PLEASE LIST EXACTLY AS IT APPEARS ON PASSPORT)
Please fill out ALL the fields for your Companion if you have one.
First Name - M. Initial - Last Name:
Companion First Name - M. Initial - Last Name:
Birth Date - Place of Birth:
Companion Birth Date - Place of Birth:
Passport # - Place of Issue:
Companion Passport # - Place of Issue:
Citizenship - Date of Issue - Expiration Date:
Companion Citizenship - Date of Issue - Expiration Date:
HOTEL ACCOMMODATIONS:
HEADQUARTERS CONGRESS HOTELS:
TYPE OF ROOMS:
FLIGHT DETAILS:
From:
ARRIVAL IN KIEV
DEPARTURE FROM KIEV
Date:
Airline Flight #:
Time:
Date:
Airline Flight #:
Time:
To:
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Special Request: (Diet, Medical, Needs or Any Other Travel Arrangements):
OPTIONAL POST CONGRESS TOURS:
1 - Three Day Tour to Western Ukraine - Lviv
Double occupancy .................$ 540.00................
Single Supplement .................$ 220.00................
2 - Three Day Tour to Southern Ukraine - Odessa
Double occupancy .................$ 850.00................
Single Supplement .................$ 220.00................
3 - Four Day tour to St. Petersburg - Russia
Double occupancy .................$ 1,150.00................
Single Supplement ............... $ 400.00................
PLEASE SUBMIT YOUR RESERVATIONS FORM IN ORDER TO SECURE YOUR HOTEL RESERVATIONS.
SPACE IS LIMITED.
FORM OF PAYMENT:
1. BY CREDIT CARD (If you're paying by Credit Card, please fill out ALL the fields below)
Credit Card # :
Exp. Date:
Card Holder Name:
Amount authorized $:
BILING ADDRESS:
*
I accept on behalf of all members of this reservation the terms and conditions of this itinerary:
Date:
* Required field
3. BY BANK WIRE TRANSFER FROM ABROAD :
Swift Code - CHASUS33 JP Morgan Chase Bank -
For Credit First National Bank of Long Island -Routing # 144 – 7 – 08673
Credit Account of Beneficiary: Conference Travel International - 01 - 7440033
Wire Transfer from USA Bank - Routing # 021411335 Credit Account 01-7440033
A Full payment for all services is due 90 days prior arrival.
RESERVATIONS WILL BE ACCEPTED ON A FIRST COME BASIS WHILE SPACE IS AVAILABLE.
NO RESERVATION WILL BE HONORED WITHOUT FULL PAYMENT .
Conference Travel International Inc.
(516) 299-5220 -- (800) 527-4852, Fax: (516) 299-5221 Email: malonso@wjatravel.com
www.wjatravel.com
RESERVATIONS WILL BE ACCEPTED ON A FIRST COME BASIS WHILE SPACE IS AVAILABLE.
NO RESERVATION WILL BE HONORED WITHOUT FULL PAYMENT
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Conference Travel International Inc.
P.O.Box 441
Glen Head, N.Y. 11545
(516) 299-5220 --- (800) 527-4852 --- Fax: (516) 299-5221
Email: reservations@wjatravel.com
2. BY CHECK
ALL PRICES ARE NON REFUNDABLE AND SUBJECT TO CHANGE -
ALL SERVICES AS PER TERM AND CONDITIONS
A DEPOSIT OF $ USA 500.00 PER PERSON IS DUE AT THE TIME OF BOOKING.
A Full payment for all services is due 90 days prior arrival.
Please make check payable in $ USA and mail with this completed reservation form to:
Conference Travel Int. Inc.
P .O. Box 441 - Glen Head, New York, N.Y. 11545