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.
Copyright © 2007 - La Dolce Vita Wine Tours, Inc. - All rights reserved.
Website Design & Programming:
Aaron Design, Inc.
&
Canfield Design Studios, Inc.