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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