BIRD HOLIDAYS BOOKING FORM - please print this form and post to us at Bird Holidays, 10 Ivegate, Yeadon, Leeds, LS19 7RE

Please use BLOCK CAPITALS

	TITLE	FIRST AND LAST NAMES – EXACTLY AS SHOWN ON PASSORT	FIRST NAME YOU WISH TO BE KNOWN BY	DATE OF BIRTH	TICK IF SINGLE SUPPLEMENT REQUIRED
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	NATIONALITY	PASSPORT NUMBER
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NAME:

ADDRESS:

POSTCODE:

TELEPHONE (DAY):

TELEPHONE (EVENING):

EMAIL ADDRESS:

HOLIDAY DESTINATION

DATE COMMENCING

DATE RETURNING

DEPARTURE AIRPORT

SPECIAL REQUIREMENTS (EG VEGETARIAN)

Details of Insurance cover can be found here. Unless you enter 'NO' on the following line and give details of your insurance company, insurance will be issued for you.

_______________________________________________________________________________________________________

I enclose a cheque/money order/credit card for £ ..................... being the deposit (and insurance premium) for ........... persons.

Payable to BIRD HOLIDAYS LIMITED. For details of deposit and insurance please refer to the end of each holiday write-up.

If you wish to pay by credit card please give details overleaf (cardholder's name, card number, expiry date, type of card).

Name, address and phone number of next of kin (not travelling) ___________________________________________________

_____________________________________________________________________________________________________

Does any of the above have a medical condition which we should be aware of (eg. diabetes, epilepsy etc.)? Yes / No If 'yes' please give details overleaf.

I have read the conditions of booking and insurance and confirm that I am authorised to accept them on behalf of all the above named persons.

Signature of first named person _______________________________________________________ Date ______________

Please return completed booking form to:

BIRD HOLIDAYS, 10, IVEGATE, YEADON, LEEDS, LS19 7RE

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