Tour Name:

 

________________________________

 

Tour Date: ___________  Cost Per Person: _________

 

Name of Traveler(s):                                               Date of Birth:

 

______________________      ________

 

______________________      ________

 

Address: ____________________________

 

City: _______________State: ____  Zip: _____

                          

Phone Number: (____)   _____ - _________

 

**************************************************

 

Amount Enclosed:  $____________   Cash / Check (circle one)

 

Credit Card # _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

 

Exp. Date: ___ /___

 

Amount to be charged: $ __________

 

Credit Card Signature:

 

________________________

 

Please bring or send completed form to:

                                Gannon Travel Associates

                                2315 N. Webb Road

                                Grand Island, NE   68803