Calgary Stampede Agricultural Tour LT1043 : July 4 - 12, 2015 Title Surname (Mr, Mrs, Dr) Title Given Names (as appear on passport) Given Names (as appear on passport) Surname Date of Birth (mm/dd/yy) Preferred Name Date of Birth (mm/dd/yy) Preferred Name (Mr, Mrs, Dr) Mailing Address Street City Postal/Zip Code Province Country Home Business Email Phone Cellular Fax PLEASE FAX OR SCAN AND EMAIL A COPY OF YOUR PASSPORT Relationship Home Phone Cellular PASSPORT Emergency Contact Name Address Business Phone Please indicate the size required for Western Style Tour Shirt: Womens: Small Large Mens: Small Large Medium XLarge TOUR PRICING: Twin Share $3226.00 per person Medium XLarge Single rate: $4308.00 X Deposit: $500.00 Per person Payment Details: Space will be allocated on a first come first serve basis Initial Deposit of $500 per person is due upon booking to secure your seat. Deposit must be received no later than March 1st, 2016 Final Payment due May 2nd, 2016 FINAL PAYMENT MAY BE PAID VIA CHEQUE OR CREDIT CARD: PLEASE MAKE PAYABLE TO LEADER TOURS INC. Cancellation & Trip Interuption Insurance: Age 0 to 59 = $188.80/ Age 60-64 = $213.00/ Age 65- 69 = $234.20/ Age 70- 74 = $265.40/ Age 75 - 79= $372.60 I authorize Leader Tours Inc. to charge my credit card for the following: Visa/Mastercard/AMEX Credit Card Number: ________________ / ________________ / ________________ / ________________ Date of Expiry ________ / ________Name on Card: Insurance Amt CAD $ Deposit Amt CAD $ 3 DIGIT CVV ____ ____ ____ Total Am . CAD $ Signed: Date: Package is 100% non-refundable Cancellation Insurance must be purchased with this tour package or you must provide proof of coverage through your insurance provider This constitutes our offer for cancellation coverage. Signature: BOOKING CONDITIONS: 1. Tour deposit is non-refundable - deposit must be received no later than March 1st, 2016 2. Tour Package is 100% non-refundable once final payment has been made (Please make sure you are covered by cancellation insurance) 3. Guaranteed tour departure with a minimum of ___ 30 passengers 4. Tour itinerary is subject to change 5. Deposit must be received at the time of booking, final payment is due by May 2nd, 2016 6. Final payment may be paid via cheque, credit card or bank transfer 7. I have read, understand and accept the booking conditions 8. I am physically able to travel. Signature: Date: Group Travel Agent: Leader Tours Inc. Office: 403-270-7044, Email: [email protected] or [email protected] Mailing address: Leader Tours Inc: 114, 3907 3A Street NE Calgary, AB T2E 6S7. Booking forms to be filled and faxed or emailed back to 403-270-4212 Attention Lawrence Rowley or Sawyer Asmundson Special Requirements - Please mention any special needs or requirements that the tour leader should know about (eg: Medical Conditions, Medications, Dietary Requirements, Allergies, Disability, Impairment, other…)