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Prelude Companion Registration Form

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Prelude Companion Registration Form Please use blue or black ink, print in CAPITAL LETTERS and fill in circles completely. Do not staple anything to this form. Address City State Zip Code Home Telephone Email Mr. Ms. Mrs. Dr. Br. Sr. Gender: M F you must be 18 or older Encore requires that you accept/decline protection U.S. departure city ___________________________________ . Protection Plan: I have read and agree to the Terms and Conditions, companion trip fees and cancellation penalties. Signature Date Signature Rooming Choice single room at $85 extra per night Please book me in a: double room, sharing with _______________________________________________ 2 single beds 1 double bed Transportation Personal Information Prelude My trip is: a Free Companion Trip paid for at the companion rate (payment enclosed) please bill me Last Name Group Leader's Group # I am booking a connecting flight to my Encore departure city Yes: Sign me up for the Ultimate Protection Plan. Estimated travel time to departure airport ____ hrs. (Encore cannot guarantee evening departures.) YYYY DD / MM / Birthdate No P.O. Box Yes: Sign me up for the Comprehensive Protection Plan. No: I decline the additional coverage beyond the Basic Protection Plan. Please book me for _____ extra day(s) at the beginning and/or _____ extra day(s) at the end of my trip. Optional Services I will be billed $50 per person for extending my ticket. I will arrange my own accommodations for the extra days. Encore will provide accommodations for me based on: Twin/double room at an additional $130 per person per night Single room at an additional $210 per person per night Triple room at an additional $130 per person per night Middle Name First Name Last Name (AS IT APPEARS ON PAS S PORT) Passport Info Passport Number Issue Date Expiration Date Country of Issue (See www.encoretours.com/go/prelude.cfm for companion price chart & US gateways.) Please quote me a price from a different departure city not listed (specify city): ___________________________________________ 17284

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