design express provence registration form
 
 
Kimberley Seldon’s DESIGN EXPRESS™: PROVENCE
Thursday, June 12 to Monday, June 16, 2008

PLEASE FILL OUT THIS FORM AND RETURN WITH 50% PAYMENT DUE UPON REGISTRATION.  FULL PAYMENT DUE MARCH 1, 2008

**NOTE:  SPACE IS LIMITED, PLEASE RESERVE EARLY.

Attendee Name:
Mailing Address:
City:
Province:
Postal Code:
   
Email Address:
Phone:


ROOM OPTIONS (please select room option)

All prices include breakfast each day, luxury coach travel each day, admission to all events and museums, all shop-and-learn sessions with Kimberley, plus a farewell group dinner with wine.  Price does not include airfare. 

Signup (select at least one below)  
Superior City or Mountain-view Room (double occupancy)

Name of Requested Roomate
Superior Full Sea-view Room (double occupancy)

Name of Requested Roomate
 $5,895.00
Superior City or Mountain-view Room (private) $6,495.00
Superior Full Sea-view Room (private) $6,895.00

Sub Total
GST (5 %) $
TOTAL AMOUNT $

PAYMENT

Make payment by cheque, cash, or credit card (Visa and MasterCard only). 50% to register, balance on March 1, 2008

*Trip is non refundable*

A representative from our office will contact you via telephone to request credit card information for payment.  Visa or MasterCard only (no American Express please)

 I authorize Kimberley Seldon Travel Group to charge my credit
        card for 50% of the total amount of the trip.  I understand that
        the balance of the total amount will be charged to my card on
        March 1, 2008.
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