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 $799.
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. I understand that if one is not available, I will be charged for a single room rate.

Your reservation will be considered official only after the deposit (per person) has been received by Far Horizons. Should you cancel after your reservation has been received, the cancellation penalties in the "Tour Conditions" will 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 $500 per person for the trip to: Portugal * Spain * France

Far Horizons
860 Wyckoff Ave
Mahwah, NJ 07430