Please print out this application, complete and mail with deposit and insurance payment to: Select International Tours and Cruises, Inc. 85 Park Avenue , Flemington NJ 08822 .

We advise you to read the Terms and Conditions, which govern this reservation and can be found on this web site, before you mail in the payment.

Last name­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­____________________________________

First name____________________________________

Middle name_________________ (must be exactly the same as on the passport)

Street......................................City...............................State.............

Zip Code--------------------------E-mail--------------------------------------------------------

Home Phone----------------------Cell Phone-----------------------Work Phone................

Passport #---------------------------Exp. Date-------------------------DOB-------------------

Group Name---------------------------------------------Group Departure Date---------------

Departure City ----------------------------------Roommate---------------------------------------Double or Single Room

Enclosed is : $----------------------------------------------------------------deposit/final payment

I am purchasing trip cancellation insurance Yes/No Payment enclosed: --------------

Optional Upgrade: Cancel for Any Reason     Yes/No

Special needs: ---------------------------------------------------------------------------------------

Please make check payable to Select International Tours, Inc.

Signature:---------------------------------------------------------------------------------------------