One Form For Each Customer. This Form is Strictly
Confidential.
Please print this Booking Form, fill in, sign and
return via mail to the
address provided below. You must hold a current
(valid) passport and obtain
a visa for Ukraine if required for your country. Ask for our help if needed.
1. PERSONAL DATA
Name:
..............................................................................................................
Address:............................................................................................................
State:.......................................Zip
Code:....................Country:.......
.......
Phone:
Day):.....
........................................Fax:...............................................
Phone
(Eve):................................................DOB:
(MM/DD/YYYY)
.
Email:
.......
Additional data (optional)
Do you speak Ukrainian (circle) )
Yes No Some
Have you visited Ukraine before? (circle)
Yes No
2.TRAVEL INFORMATION
HOW will you travel to Kyiv ? (circle) :-
1. Air 2.Train 3.Other
Select accommodation and other information
(circle):
Double Yes No
Single (+US $350) Yes No
3. PAYMENT
Total payment for a double occupancy (land only)
is $1,950 per person. Please enclose a deposit of $500 by
a personal check or money order, payable to
Kolos Corporation, or provide your credit card
information:
Credit card: (VISA, MasterCard)
Card number
..
.
Expires (MM/YY):
..
Cardholder name
..
Billing address (If different from the address
provided above)
The remaining part of the total amount should be paid
minimum 4 weeks before arrival. Information package
with the list of recommended things to take with you,
details of hotel and trip accommodations, schedules,
maps and the recommended reading about Trypillian
culture will be provided upon your deposit
confirmation receipt.
Your Signature:
...............................................
Date:
. |
