Jack Lim China Qigong Study Tour Booking Form
CHINESE REFLEXOLOGY & QI ENERGY TOUR
April 28 - May 16 2009
Press the Print button on your browser to print the following booking form:
BOOKING FORM
(Overseas participants are welcome to join - please contact Jack for more information)
Please reserve ___ tickets for,
Your Name/s _______________________________________________________
I forward a NON-refundable deposit of $200 (per person). Cheques written to Jiangsu China Travel Service. Overseas/interstate members US$200.
Cash Cheque Visa M/card B/card
Card no.
Expiry Date ____/____ Name on Card ___________________________
Signature ______________________________ Date _______________
Name (as on Passport) ____________________________ Email__________________________
Phone No. (H)_______________________ (B)_______________________
(M) _______________________ Fax_______________________
Address _______________________________________________________________________
__________________________________________________________ Post Code ___________
Nationality (as per Passport) ______________________ Passport No______________________
Expiry date ______________
Issue date_____________ Place of issue ______________________
Visa No (later)_____________________ Visa category( later)__________________________
Next of Kin: Name________________________________________________________________
Next of Kin: Address______________________________________________________________
_______________________________________________________________________________
Next of Kin: Phone______________________________
If sent to Jiangsu China Travel, please send a copy to Deborah Jonston,
161 Canterbury Rd,
Toorak VIC 3142.
Enquiries about the itinerary please contact Jack Lim.
