Registration Form for China-Tibet Tour: Journey to Shangri-La April 11-27, 2012

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Dao of Well-Being Tours™ & Qigong China Trips
PO Box 750,    Ely, MN 55731  USA
phone: 218-365-6330 or 1-800-341-8895

Today's Date______________

Name_____________________________________

Address___________________________________

Gender______

City______________________________________

State___________________

Country___________________

Postal Code /Zip Code_______________________

Phone Number______________________________

E-Mail Address______________________________

Trip Date:  April 11-27, 2012 China & Tibet Tour - Journey to Shangri-La

Shared Room  (     )    or    Single Room - when available $655.00 additional (     )

Name of preferred room mate - if applicable ____________________

Please list any Allergies: _______________________________________________________________

Please tell us of any Health Issues which could limit your participation in the trip: _______________________________________________

Trip Fees for China & Tibet Tour - Journey to Shangri-La April 11-27, 2012: 

Early-bird registration: $3,900.00 for registration by Dec. 31, 2011 (double occupancy)

$4,150.00 (for registration after Dec. 31, 2011)
     Save $100.00 each person, for 2 or more people registering together.
Deposit: Confirm your registration with a deposit of $800. 
Deposit Fee $800.00 a deposit of $800 with hold your space. balance due by February 10, 2012

Payment Type Enclosed: Check (  ) Money Order (  ) Master Card (  ) Visa (  ) Discover (  ) American Express (  )
                                                                        (fee reflects cash discount - if you are paying by credit card add 3%) 
Please make checks payable to: Dao-Of-Well-Being/China Trip
 
For Master Card, Visa, Discover or American Express  payments:

Name as it appears on your card _______________________________

Credit Card number: _________________________________________  Expiration date: ___________   CVS#______(3 digits on card back)

Credit card billing address:______________________________________________________________

Signature: ____________________________________

Please mail your reservation and deposit to:

Dao of Well-Being™
PO Box 750
Ely, MN 55731