Jordan Extension Registration Form

Jordan Extension Registration Form
(One Per Traveler)

Here you have the option of Completing Online Registration and Payment

OR

You can Complete this Registration Form, Print and Mail with Payment to:

DuCar International Tours

201 Huntingwood Blvd.

Lynchburg, VA. 24503

Any Questions? call : 1-434-941-8886
Registration Date

MonthDayYear
Last Four (4) Digits of Traveler's SSN*
FULL Passport Name*

First NameMiddle NameLast Name
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Home Phone Number*
Cell Phone Number*
Roommate Request
Gender:*

MaleFemale
Roommate Request
Accommodations

Room Type
Tour Packages are based on a Double Occupancy Room Accommodation
Choose Room Type:*

Double OccupancySingle Occupancy (additional $300.00 charge)
Extension Tour Package

Includes Travel and Accommodations
Choose One:*

Double Occupancy, $1,950.00Single Occupancy (w/additional $300.00 charge), $2,250.00
Insurance Payment Options
For an Additional Fee

You have the option here to have a single occupancy room.
Insurance (REQUIRED): Trip and Cancellation insurance is mandatory*
If you wish for an Upgrade to Business Class Please call

DuCar Tours for current pricing

at: 1-434-941-8886
Signature
Order Summary
Please take a moment to review your order.
Total Due:
Payment
Please indicate whether you're using Credit or Debit

CreditDebit
Credit Cards Only; we are not accepting Debit Cards.

USDCheck Out

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

If you choose to mail Completed Registration Form and Payment,

We Accept:

Check, Money Order, Cashiers Check and Credit Cards
Should be Empty:

Jordan Extension Registration Form

Roommate Request

Accommodations

Extension Tour Package

Insurance Payment Options

Order Summary

Please take a moment to review your order.

Payment