PERSONAL INFORMATION:
Name (as it appears in passport): _________________________________________________________________
Address:____________________________________________________________________________________
City: ________________________________ Zip/Postal Code: ______________ State/Country:_______________
Telephone: _______________________(day) _______________________ (evening) __________________ (cell)
FAX: _______________________________ E-mail: _______________________________________________
Passport #: _________________ Issue Date: _________ Expiration Date: _________ Place of Issue: __________
Citizenship: _____________________ Date of Birth : ______________ Place of Birth: _____________________
Occupation: _______________________________________ Age: ______________ Sex:
___ Male ___ Female
Smoker: ___ Yes ___ No
Vegetarian:
___ Yes ___ No
Do you have any health conditions of which we should be aware of?
___ No ___ Yes (please describe below, or attach explanation):
___________________________________________________________________________________________
EMERGENCY CONTACT INFORMATION:
Name: __________________________________ Telephone: _____________ (day) ______________(evening)
Address: ___________________________________________________________________________________
TOUR BOOKING & DEPOSIT:
GROUP TOUR:
Tour name: ________________________________ Tour Code: ____________ Tour starting date: __________
CUSTOM TOUR:
Tour Code (As given by JJA) : _______________ Tour Duration: __________days Tour starting date: ___________
I wish to pay my tour deposit of $ ___________________ for booking the above tour by:
___ Check ___ Money Order ___ Credit / Debit card (You can pay online using your credit card, just email us: choy@jalan2asia.com)
Name of card holder: _________________________________________ Card #: __________________________
Expiration Date: _________________________ Signature: ____________________________________________
I understand that the final balance is due within 60
days of the tour commencement date and that penalties apply
as described under Jalan Jalan Asia's "Terms and Conditions."
ACCOMMODATION:
Please note that for group tours, all accommodation is based on a twin-share basis. If you request single accommodations,
a single supplement will apply. However, if you have agreed to share a room and if there is an odd number of participants,
you willl not be charged a single supplement if you are allocated a single room.
___ I agree to share a double room. I like to share room with : ___________________________________________
___ I prefer a single room (if available) and agree to pay the single supplement.
Please e-mail this form back to:booking@jalan2asia.com.
