sign-up sheet - Inner Wheel Deutschland

SIGN-UP SHEET
Obligatory booking registration for the Costa Mediterrana cruise.
DATE: 23. - 30.04.2017
Cabin:
❏ INTERIOR PREMIUM DOUBLE ❏ OUTSIDE PREMIUM DOUBLE ❏ BALCONY PREMIUM DOUBLE
❏ OUTSIDE PREMIUM SINGLE USE
❏ BALCONY PREMIUM SINGLE USE
SURNAME: __________________________________NAME:_______________________________________________________________________
SURNAME: __________________________________NAME:_______________________________________________________________________
ADRESS:��
_____________________________________________________________________TEL.:��
E-MAIL:_________________________________________________________________________________________________________________
CITIZENSHIP: __________________________________________________________ PASSPORT NUMBER:__________________________________
DATE OF ISSUE: _______________________________________________________________EXPIRY DATE:__________________________________
PLACE OF BIRTH: ________________________________________________________ AUTHORITY STATE:__________________________________
NAME AND TELEPHONE NUMBER FOR EMERGENCIES:��
Piu gusto Paket price per day and person € 27,99: ❏ JA
❏ NEIN
Travel complete Insurance € 52,-: ❏ JA
❏ NEIN
Arrival:
❏
❏
❏
❏
INDIVIDUELL
BUS from ❏GRAZ
❏MÜNCHEN ❏ SALZBURG ❏WIEN - price on request
CARARKING RESERVATION IN VENICE - payable Locally
FLIGHT to VENEDIG - price on request
______________________
PLACE AND DATE
Information and reservations:
GRUBER-reisen., Südtirolerplatz 13, 8020 Graz
Tel. 43 316 7089 6600
[email protected]
www.gruberreisen.at
__________________________________
SIGNATURE

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