La Dolce Vita Wine Tours

Please fill out and submit this form, or you may also print, fill out, and mail or fax this form to:

La Dolce Vita Wine Tours, Inc.
576 Fifth Street
Brooklyn, NY 11215

Fax: (718) 499-2618

First Applicant Name & Address

Full Name
Address1
Address2
City	State: Zip:
Passport Number
Date of Issue
Birthdate
Telephone	Day: Eve:
Fax
E-mail

Second Applicant Name & Address

Full Name
Address1
Address2
City	State: Zip:
Passport Number
Date of Issue
Birthdate
Telephone	Day: Eve:
Fax
E-mail

Tour & Departure Dates

Tour Name:

Departure date:

Accommodations

We are traveling togther and would like:

One double bed Two twin beds

I am traveling alone and would like to share a room.

I would like a single room. (single supplement applies)

For Bike Tours

I/We will bring # of bikes.

I/We would like to rent # bikes.

Party 1:

Road Bike Men's Hybrid Women's Hybrid Tandem

Bike size your height inseam

Toe Clips:

Own helmet Need to rent helmet ( Small Large)

Party 2:

Road Bike Men's Hybrid Women's Hybrid Tandem

Bike size your height inseam

Toe Clips:

Own helmet Need to rent helmet ( Small Large)

For Day Tours

City of pick-up:

Hotel name:

Hotel address:

Hotel telephone:

Deposit & Payment

A deposit of $400 per person is required for the full tours, or $120 for day trips.

Payment is accepted by check (payable to La Dolce Vita Wine Tours, Inc.) or credit card (Visa and MasterCard only).

Mail check to: 576 Fifth Street, Brooklyn, NY 11215.

For credit card payments, call 888-746-0022.

Balance is due 60 days before week-long tour departures, or 30 days before day-tour departures.

Agreement

I/We have read and agree to the terms and conditions set forth by La Dolce Vita Wine Tours, Inc. In addition, I/we understand that a waver will be sent and must be signed by each participant.