Your Name and Address:
Title: (Mr., Mrs., Miss, Rev.)
First Name:
Last Name:  Suffix:  ** Jr. Sr. MD DDS PHD II III
Postal Address:
(second line...)
City:  State:  AB AL AK AZ AR BC CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA LB MA MB ME MD MI MN MS MO MT NB NC ND NE NF NH NJ NM NS NT NV NY OH OK ON OR PA PE PQ PR RI SC SD SK TN TX UT VI VT VA WA WV WI WY YT    ZIP/Postal code
Phone: Email address:

I would like to occupy a single room at an additional $999.
I plan to share a twin-bedded room with:
I would like Far Horizons to select a roommate (if available) to share a twin-bedded room with me.  If not available, I understand that I will be charged the single supplement.

Your reservation will be considered official only after your full payment has been received. Should you cancel after your reservation has been received, the cancellation penalties in the "Tour Conditions" apply. 

I/We have read and agree to the terms and conditions which apply to this tour, especially noting the cancellation and responsibility clauses.

Signature: ____________________________ Date:_____________________

Sign your printed copy and mail this form along with your deposit of $1000 per person for the trip to: ITALY

FAR HORIZONS
135 Chestnut Ridge Rd
Montvale, NJ 07645