HEAVENLY INTERNATIONAL TOURS
PROFESSOR MARK BRAUN

REGISTRATION FORM
INSPIRATIONAL TOUR OF ROME & SOUTHERN ITALY
March 6 – 15, 2004

NAME (1)_______________________________________________________________

 (Legal name as appears in your passport) - Please print

NAME(2)________________________________________________________________

ADDRESS_______________________________________________________________

CITY________________________________STATE________ZIP___________________

MY ROOMMATE’S NAME IS: ________________________________________________

HOME PHONE: ________________________WORK PHONE: ______________________

DATE of BIRTH 1)___________________ 2) DATE of BIRTH_______________________

PASSPORT NUMBER 1)______________________ (2)____________________________

NAME TAG SHOULD READ: _________________________________________________

MY E-MAIL ADDRESS IS: ___________________________________________________

I have read the Tour Conditions & Cancellations policy of the section of the brochure and understand the cancellation policy.  I understand that deposits are non-refundable and final payment is due January 10, 2004.  I also understand that if I wish to cancel my tour, the Terms and Conditions as stated in brochure will apply and be enforced. I am aware that I am responsible for adequate personal and medical insurance. (Please note that Heavenly Tours will be unable to proceed with your reservation without your signature on this form.)

SIGNED: ___________________________________ DATE______________

Make check payable to: Heavenly International Tours

Mail this form with your deposit to:

HEAVENLY INTERNATIONAL TOURS
3900 W. Brown Deer Rd. - Suite A134
Milwaukee, WI  53209

  (800) 322-8622 or (414) 352-6522

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