Registration Form H Katz

HARMONY KATZ
REGISTRATION FORM
IRELAND TOUR
OCTOBER 20-28, 2019

* Indicates required field

Last Name as it appears on your Passport *

Middle Name as it appears on your Passport *

First Name as it appears on your Passport *

Date of Birth *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Residence Phone Number *

Cell Phone Number *

Work Phone Number *

Email *

TRAVEL INSURANCE *

Yes, I Want Travel Insurance No I DO NOT want Travel Insurance

Need more information? *

Yes, please call me.

If double occupancy, list Roommate's Name *

Need a single room? (extra cost) *

yes no

Submit

TLC Tours, 142 Winthrop Street, Medway, MA 02053.
Email: Leo@TLCTours.com
Travel insurance ($209.00) must be purchased with initial deposit.