| Please
Note |
If you have any questions prior to
submitting your request, please call us at
416-235-1212 or
email at info@designtravel.ca. |
|
| Couples and families travelling
together must register individually. |
|
All fields are required. If you do
not have the information, type and "X" in the field
and a representative
will contact your to obtain all of the missing
information. |
|
By filling out and submitting this
form, you are requesting a reservation for a
particular package. We
will contact you with a confirmation of a reservation,
air travel, insurance and payment after receiving
your request. |
|
| Contact
Information |
| First Name: |
|
| Last Name: |
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| Street Address: |
|
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| City: |
|
| State/Province: |
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| Zip/Postal Code: |
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| Country: |
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| Age: |
< 2 yrs. 2 - 11 yrs. 12 - < 18 yrs. 18+ yrs.
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| Phone (D): |
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| Phone (E): |
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| Cell phone: |
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| E-mail: |
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| Fax: |
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| Occupation: |
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| Reason for travel: |
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Where did you learn about us:
|
Internet
Email notice
Yellowpages
Friend
Other |
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| Trip
Information |
| Tour Package: |
|
| Departure Date (yyyy/mm/dd): |
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| Return Date (yyyy/mm/dd): |
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| Departure City: |
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| Arrival City: |
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Excursions:
|
Havana Only
Bar Night
Botanical Garden
Overnight Cienfuegos,
Topes & Trinidad Tour
Troll Fishing
Vintage Car City Tour |
Havana & Varadero
Deep Sea Fishing
Swimming with
Dolphins
|
Varadero Only
Coral Sailing
Mantanza Splash
Tandem Jump
Tour Varadero
Trinidad & Topes de
Collantes by Helicopter |
Would you like us to
arrange your flight? |
Yes No
|
| Accommodations: |
|
Do you want travel insurance?
(Strongly Recommended) |
Yes No, I decline travel insurance
|
|
| Passport
Information |
Name on Passport
(Last, First, Middle): |
|
| Passport No: |
|
| Expires on (yyyy/mm/dd): |
|
| Dat of Issue (yyyy/mm/dd): |
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| Issuing Country: |
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| Citizenship: |
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| Place of birth: |
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| Date of birth (yyyy/mm/dd): |
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| Gender: |
Female Male |
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| Emergency
Contact Information |
| Full Name: |
|
| Relationship: |
|
| Phone: |
|
| E-mail: |
|
