Reservation Form

Name of Tour:     Bachmann Peru/Ecuador Tour 2011
Departure Date:                          Home City / Airport: ___________
Name (Legal name same as on your passport, please)
Last:                                                           First:   ________________
Address: ___________________________________________
City:                                                              State:                    Zip: ____
Telephone:                                                 Cell: _________________
E-mail: _________________________Company Name: ________________
Male              Female              Date of Birth: __________________
Occupation:                                                Nationality:   ____ ______
Passport No:                                               Expiration Date: _______

United/Continental Frequent Flyer Numbers
#:                                                          


Roommate                  Home City / Airport:   _______________
Name (Legal name same as on your passport, please)
Last:                                                           First:   ________________
Address: ___________________________________________
City:                                                              State:                    Zip: ____
Telephone:                                                 Cell: _________________
E-mail: _________________________Company Name: ________________
Male              Female              Date of Birth: __________________
Occupation:                                                Nationality:   ____ ______
Passport No:                                               Expiration Date: _______

United/Continental Frequent Flyer Number
#:                                                          

Enclosed is my deposit of $                    ($500 per person) for             persons.
   __   I will pay for single room supplement. (See Tour Schedule & Price)
   __   Please find me a roommate
   __   I am referring the following people on this tour:
_______________________________________________________
_______________________________________________________

Print, fill out, and send this form, a photocopy of your passport photo page, and a deposit
check ($500 per person). Please make check payable to Bill Bachmann.
Send to this address:            Bill Bachmann
                                           P.O. Box 950077
                                           Lake Mary, FL 32795-0077


Any questions email Bill:       bill@billbachmann.com