TOUR RESERVATIONS FORM

National Trust for Historic Preservation
Queen Mary 2- Winston Churchill - NTQMCH0707 - Literary Traveler

Please complete the traveler information below. A deposit of $1000 per person is required to reserve a place on The Queen Mary. Deposits may be made by credit card or check.
Visa [  ]  MasterCard [  ]

METHOD OF DEPOSIT*

Please reserve _______spaces on this tour. A total of $_____________
($1,000 per person) should be handled as follows:

Card Number: ______________________ Expiration Date: ___________________

______________________________ ____________________________________
Name as it appears on credit card (please print) Signature

Credit cards may be used for the tour deposit and airfare only. The balance of the program price must be paid by check upon receipt of invoice approximately 120 days prior to departure. If you elect to charge your airfare to a credit card, the international ticket will be charged to your account approximately three weeks prior to departure.

Names(s) for Name Badges

_____________________________________________________________________
Name #1                                                                                        Date of Birth

______________________________________________________________________
Name #2                                                                                        Date of Birth

______________________________________________________________________
Street Address ---- City ----- State ----- Zip Code

______________________________________________________________________
(Area Code) Daytime Telephone --- Evening Telephone

______________________________________________________________________
Fax                                                          Email

Accommodations:

Cabin Preference:   B1 -  B2 -  B3 -  B5

1st Choice: __________ 2nd Choice:  ______________

Single Applicants Only:

[ ] I prefer single accommodations.
[ ] I plan to share accommodations with: ____________________________________
[ ] Please arrange a share for me (not guaranteed).
[ ] I am a smoker [ ] I am a non-smoker

National Trust Study Tours are open to members only. If you are not a member of the National Trust,  please enclose a separate check with this form payable to the National Trust for Historic Preservation for a one-year membership as follows:

[ ] $20 individual [ ] $24 family
I (We) are National Trust members. My/our membership number is ___________

[ ] I/ We have read the terms and conditions for the trip and agree to them

STATEMENT OF RESPONSIBILITY. The undersigned has read the schedule of activities for Churchillâ??s England aboard Queen Mary 2, July 6-15, 2007, and accepts any risks therein. The undersigned hereby agrees and assigns to release and hold harmless the National Trust for Historic Preservation and any of its officers, agents, licensees or representatives from any and all liability for delays, injuries or death; for the loss of or damage to his/her property; or for personal injury or property damage to others caused by him/her, however occurring, during any portion of, or in relation to Churchillâ??s England aboard Queen Mary 2, September 4â??13, 2007.

______________________________________________________________________
Signature ----- Date                                             Signature ---- Date

Please send the completed reservation form to: National Trust for Historic Preservation, STUDY TOURS, c/o Bank of America, P.O. Box 320, Washington, D.C. 20055-0320. Or you may fax your reservation to NATIONAL TRUST STUDY TOURS at the following number:

Fax : (202) 588-6246

 

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