Chad Mitchell Trio Ireland Tour – March 15-23, 2012

                                                                                           Today's date:                                      

Name: __________________________________________Citizenship ______DOB:____________

            Legal name as it appears on passport (no nicknames)

Mailing Address __________________________________________City/State/Zip:______________________________

 E-Mail: __________________________________Tel.__________________________ Cell:__________________________

Rooming with: ________________________________Tel._____________________ Citizenship_________ DOB: _____________

Emergency contact__________________________________________________________________________________________

                                            name                                                         relationship                                                      telephone

Land Package: ____ persons@ $2295 (double occupancy)     Air from NYC: ____ persons@$699       Insurance: ____ persons

Single Supplement - $550 (Limited!)

Deposit $350 per person upon reservation (plus $100 deposit for airfare, if selected)

Final Payment due January 6, 2012

CHECKS MAY BE MADE PAYABLE TO:  Traveling Troubadour.  Send to P. O. Box 3189, Staunton, VA  24402

Please charge my credit card      ___Visa   ___Discover   ___Master Card    ___American Express

                                                                        (Note:  Payment may be processed through Pay Pal.)

Credit Card #___________________________________________Exp. Date___________

Cardholder’s name_________________________________ SIGNATURE______________________________________________