PILGRIMAGES ABOUT US GROUP PILGRIMAGES LOURDES BY TRAIN SPECIAL OFFERS INSURANCE

BOOKING FORM      14

                                                                                                                       ST. CLARE’S TRAVEL

79 Quintilis

Bracknell

Berks  RG12 7QQ    

Telephone  01344 641524

        Please complete using  BLOCK CAPITALS  ( all names as per passports )


        Name : ……………………………………………………………Age: ……………………………….

        Address: …………………………………………………………………….…………………………….

        …………………………………………………………………………………………………………………..

        Post Code :……………………………                    Telephone No.:…………………

        I wish to reserve  ………….. places on a ........... day pilgrimage by ................departing on

        …... / ...... / .......

        Names and ages of all persons in your party :

        ……………………………………………………………………………………………...………………………………………………………………………

        ….......................................................................................................................................

….......................................................................................................................................

Type of room required : Single / Twin / Double

Please specify any special requirements e.g. diets, disabilities, medical conditions, wheelchair needs

…........................................................................................................................................

…........................................................................................................................................

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       Do you require Travel Insurance : YES/ NO   ( If YES an application form will be sent to you )


       I  enclose £ ………………as a deposit plus £ …………insurance.

       The balance will be paid at least 10 weeks prior to departure. I have read the Conditions of Contract which

       I accept for myself and other members of my party.



Signature :……………………………………….                     Date :…………………………….


       PAYMENT BY CREDIT/ DEBIT CARD  –  an additional charge of £5.00 will be made for the use of this

        facility


       I wish to pay by :   VISA / MASTERCARD / MAESTRO / SWITCH

       Please charge the deposit and insurance, total of £ …………… to card number


      Start Date : …… /…… Expiry Date : …… / …….   Security &/or Switch Issue No.: …………..


      Name of Card Holder : ……………………………………………………………………..











…………………………………………………………………….……………………………..…….……………………………………………………………………………………………..………………………………………………………………………………………………………...…….…………………………………………………………………………………………………............................................................................................................................................................



Do you require Travel Insurance : YES/ NO   ( If YES an application form will be sent to you )



I enclose £ ………………as a deposit. The balance will be paid at least 8 weeks prior to departure. I have read the Conditions of Contract which I accept for

myself and other members of my party.



Signature :……………………………………….                     Date :…………………………….



PAYMENT BY CREDIT/ DEBIT CARD  –  an additional charge of £5.00 will be made for the use of this facility



I wish to pay by :   VISA / MASTERCARD / MAESTRO / SWITCH

Please charge the deposit and insurance, total of £ …………… to card number



......./......./......./......./......./......./......./......./.. ..../... .../.. ..../.... ../.. ..../... .../... .../... ..../.. ..../.. ..../

        

Start Date : …… /…… Expiry Date : …… / …….   Security &/or Switch Issue No.: …………..



Name of Card Holder : ……………………………………………………………………..