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RESERVATION APPLICATION * SPACE LIMITED * RESERVE EARLY
DANCE BAHIA™
January 13 - January 22, 2012
(Effective November 1, 2010 NAME and DATE OF BIRTH must be identical in passport and air ticket)
Name(Last) ________________________ (First) __________________________________
Middle _______________________ Date of Birth__________________________________
Address___________________________________________________________________
Apt. No._____________
City_____________________________State/Prov.____________Zip/PC_______________
Telephone(Home)__________________(Office)___________________________________
e-mail_____________________________________________________________________
Male__________Female_________Smoking__________Non-Smoking_________________
Special Assistance___________________________________________________________
Single Supplement ___ Roommate ______________________________________________
Enclosed is a deposit in the amount of____________
(Minimum deposits $250.00 - Check or Money Order Only).
Deposits should be made as soon as possible in order to reserve a space.
Balance payments accepted with Visa or MasterCard.
Final Payment due 45 days prior to departure.
Make checks payable to: YourWorld Consultant Group, Inc.
Send payment to: YourWorld Consultant Group, Inc., P.O. Box 2526, Laurel, MD 20709
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