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Costa Rica June 22 - 27, 2009 Reservation Form

An exclusive Eagle Escape for FGCU Alumni and Friends

TRIP INFORMATION

Room:

Double	$2890.00 per person
Triple	$2610.00 per person
Single	$3890.00 per person

PASSENGER(S) INFORMATION

Number of Passengers:

Passenger 1:	First Name:		Last Name:
	Passport Number:		Exp Date:
	Date of Birth:

Passenger 2:	First Name:		Last Name:
	Passport Number:		Exp Date:
	Date of Birth:

Passenger 3:	First Name:		Last Name:
	Passport Number:		Exp Date:
	Date of Birth:

Passenger 4:	First Name:		Last Name:
	Passport Number:		Exp Date:
	Date of Birth:

ADDITIONAL AIR TRAVEL INFORMATION

U.S. Departure City:	Home City:		direct to Ft. Lauderdale
	Home City:		to Fort Myers / Motor Coach to Fort Lauderdale
	Please Quote Airfare:		YesNo

CONTACT INFORMATION

First Name:
Last Name:
Address:
City / State / Zip:
Phone:	()
Alternate Phone:	()
Best Time to Call
Email:

PAYMENT INFORMATION

Deposit:	$1000.00 per person plus Travel Insurance to reserve space

Travel Insurance:	Age 18 - 34	$167.00	How many:	**
	Age 35 - 50	$198.00	How many:	**
	** Insurance for Children under 18 are included free of charge, when accompanied by a covered adult. Please add an $8.00 processing fee to each family policy.

Card Type:	Visa Mastercard Amex
Name on Card:
Card Number:
Expiration Date:	example: 11/2013

Total Amount $	Amount to be changed to my card

	Yes, I have read, understood, and accept all terms and conditions as specified.

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