IVCC Booking Form

Directions: You must fill out this form online.

Please fill out one form per room UNLESS each person is paying separately then each person will need to fill out their own form.

Once you hit submit, an email will be sent to you letting you know your submission was received.

All passports MUST be valid through December 1, 2027

A copy of your passport which you will be traveling with MUST be provided to Travel Haus if we do not have one on file for you. You will be notified if we do not have one on file for you and will be required to provide a copy NO LATER THAN December 31, 2026

I would like to book a:*

Double Room (both guests paying together)$14,958.00

Price for 2 adults sharing 1 room and paying together

Room Category

Double Room (each guest paying separately)$7,479.00

Price for 1 adult sharing a room with another adult and each person paying separately

Room Category

Single Room$ Free

Price for 1 adult in a room by themselves

Room Category

Total $0.00

Are you a member of the Indian Valley Chamber of Commerce and as such are entitled to a $200 per person discount off of the above prices?*

YesNo

Your Indian Valley Chamber of Commerce Membership is under what name/company?*

NAME 1: (EXACTLY AS IT APPEARS ON YOUR PASSPORT)*

First NameMiddle NameLast Name

NAME 1: BIRTHDATE *

Enter Month, Day & Year

NAME 1: PASSPORT COPY (Optional)

Browse Files

UPLOAD HERE

NAME 2: (EXACTLY AS IT APPEARS ON YOUR PASSPORT)*

First NameMiddle NameLast Name

NAME 2: BIRTHDATE *

Enter Month, Day & Year

NAME 2: PASSPORT COPY (Optional)

Browse Files

UPLOAD HERE

I will be rooming with (this guest is paying separately):*

ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

YOUR CELL NUMBER WHILE TRAVELING*

Area CodePhone Number

NAME 2 CELL NUMBER WHILE TRAVELING*

Area CodePhone Number

EMAIL for confirmations & trip communications*

If you do NOT have an email type none@none.com

EMERGENCY CONTACT NAME (a person NOT traveling with you)*

Enter name here

EMERGENCY CONTACT PHONE NUMBER*

Area CodePhone Number

Special Requests/Medical Needs: (meals, wheelchairs, CPAP etc). Please specify which passenger the request is for.

TRAVEL INSURANCE

Travel Haus recommends that you purchase an Allianz travel protection plan to help protect you and your travel investment against the unexpected. The protection plan we recommend, provides coverage for Trip Cancellation, Trip Interruption, Trip Delay, Emergency Medical Expenses, Medical Evacuation/Repatriation and more. For more information or to review the description of coverage prior to purchase, go to:

https://acrobat.adobe.com/link/review?uri=urn:aaid:scds:US:f627a4ae-58f7-34a5-b009-e0823c453f9f

Please Note: You may purchase coverage up to the trip final payment date. You MUST be medically fit to travel when you purchase the plan.

Terms, conditions, and exclusions apply to all plans. Insurance benefits underwritten by BCS Insurance Company (OH, Administrative Office: 2 Mid America Plaza, Suite 200, Oakbrook Terrace, IL 60181), rated “A” (Excellent) by A.M. Best Co., under BCS Form No. 52.201 series or 52.401 series, or Jefferson Insurance Company (NY, Administrative Office: 9950 Mayland Drive, Richmond, VA 23233), rated “A+” (Superior) by A.M. Best Co., under Jefferson Form No. 101-C series or 101-P series, depending on your state of residence and plan chosen. Plans only available to U.S. residents and may not be available in all jurisdictions. Allianz Global Assistance and Allianz Travel Insurance are marks of AGA Service Company dba Allianz Global Assistance or its affiliates. Allianz Travel Insurance products are distributed by Allianz Global Assistance, the licensed producer and administrator of these plans and an affiliate of Jefferson Insurance Company. The insured shall not receive any special benefit or advantage due to the affiliation between AGA Service Company and Jefferson Insurance Company. Plans include insurance benefits and assistance services. Any Non-Insurance Assistance services purchased are provided through AGA Service Company. Except as expressly provided under your plan, you are responsible for charges you incur from third parties. Contact AGA Service Company at 800-284-8300 or 9950 Mayland Drive, Richmond, VA 23233 or customerservice@allianzassistance.com.

INSURANCE CHOICE - Insurance rates are subject to change until paid for. Once you pay for your insurance, it is NONREFUNDABLE. If you reside in a state other than Pennsylvania, your rates may be different. You will be advised if they are different. THIS IS NOT A CANCEL FOR ANY REASON INSURANCE*

I would like to purchase a travel protection plan and am paying with my initial deposit so coverage begins immediatelyI would like to purchase a travel protection plan and will pay with my final payment. I understand that coverage will not begin until my premium has been received by Travel Haus. Pre-existing medical conditions are covered as long as I pay by my final payment date.I choose to decline insurance coverage and agree to assume any risk, and take full responsibility for all costs associated with any loss of, or change to, my travel arrangements. I understand this could result in the loss of my travel investment and/or require more money to correct the situation. I also acknowledge without insurance, there may be no way to recoup any loss.

INSURANCE COVERAGE AMOUNT - You MUST cover your entire trip cost. You may NOT underinsure. Please choose the correct coverage amount for your trip cost.

$645 per person - Standard Coverage up to $8000 per person$809 per person - Standard Coverage up to $10000 per person$985 per person - Standard Coverage up to $12000 per person

BY TYPING MY NAME, I AGREE TO THE TRAVEL HAUS TERMS & CONDITIONS. Typing your name constitutes an electronic signature. which is legal and enforcable in the same fashion as a traditional signature.

Once you have submitted your form, Travel Haus will place your booking on hold and email you a copy of the confirmation within 3 business days for you to review. If all is correct, please call the office by the deposit due date on the email you will be sent to provide your credit card to secure your booking.

ELECTRONIC SIGNATURE:*

Type your signature here

Once you hit submit, a confirmation email will be sent to your inbox and your registration is complete.

Travel Haus, Inc

614 E. Broad Street, Souderton, PA 18964

(215) 723-8687

Groups@TrvlHaus.com www.TrvlHaus.com

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