Registration Form for China-Tibet Tour: Journey to Shangri-La April 12 to 28, 2015

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Dao of Well-Being Tours™ & Qigong China Trips
PO Box 750,    Ely, MN 55731  USA
phone: 218-365-6330 or 1-800-341-8895

Today's Date______________

Name_____________________________________

Address___________________________________

Gender______

City______________________________________

State___________________

Country___________________

Postal Code /Zip Code_______________________

Phone Number______________________________

Cell phone number: __________________________

E-Mail Address______________________________

Passport Number: ____________________________  

Your date of birth: ____________________________  

Passport expiration date: _______________________

What country is your passport issued in? _______________________

Trip Date:  April 12- 28, 2015 China & Tibet Tour - Journey to Shangri-La

Shared Room  (     )    or    Single Room - when available $755.00 additional (     )

Name of preferred room mate - if applicable ____________________

Please list any Allergies: _______________________________________________________________

Please tell us of any Health Issues which could limit your participation in the trip: _______________________________________________

Trip Fees for China & Tibet Tour - Journey to Shangri-La April 12 to 28  2015: 

Early-bird registration: $3,900.00 for registration by December 1, 2014 (double occupancy)
$4,350.00  (for registration after December 1, 2014)
Deposit: Confirm your registration with a deposit of $800.
   
Deposit: Confirm your registration with a deposit of $800. 
Deposit Fee $800.00 a deposit of $800 with hold your space. The balance of the tour cost is due by January 15, 2014

Payment Type Enclosed: Check (  ) Money Order (  ) Master Card (  ) Visa (  ) Discover (  ) American Express (  )
                                                                        (fee reflects cash discount - if you are paying by credit card add 3%) 
Please make checks payable to: Dao-Of-Well-Being/China Trip
 
For Master Card, Visa, Discover or American Express  payments:

Name as it appears on your card _______________________________

Credit Card number: _________________________________________  Expiration date: ___________   CVS#______(3 digits on card back)

Credit card billing address:______________________________________________________________

Signature: ____________________________________

Please mail your reservation and deposit to:

Dao of Well-Being™
PO Box 750
Ely, MN 55731