HEAVENLY INTERNATIONAL TOURS
PROFESSOR MARK BRAUN

REGISTRATION FORM
INSPIRATIONAL TOUR OF ROME & SOUTHERN ITALY
March 6 – 15, 2004

NAME (1)_______________________________________________________________

 (Legal name as appears in your passport) - Please print

NAME(2)________________________________________________________________

ADDRESS_______________________________________________________________

CITY________________________________STATE________ZIP___________________

MY ROOMMATE’S NAME IS: ________________________________________________

HOME PHONE: ________________________WORK PHONE: ______________________

DATE of BIRTH 1)___________________ 2) DATE of BIRTH_______________________

PASSPORT NUMBER 1)______________________ (2)____________________________

NAME TAG SHOULD READ: _________________________________________________

MY E-MAIL ADDRESS IS: ___________________________________________________

• Enclosed is my check/money order for deposit: ($400.00) per person______
  (Due on or before November 1, 2003)
   
• I want a single accommodation for an added $337.00 Yes____ No_____
   
• I have previously traveled ___ with Heavenly Tours. Please include my reduction of
  $50.00 for each previous tour. Dates of previous tours: _____|_____|_____|____|____
   
• I have paid my deposit prior to October 10, 2003 Yes _____ No _____

I have read the Tour Conditions & Cancellations policy of the section of the brochure and understand the cancellation policy.  I understand that deposits are non-refundable and final payment is due January 10, 2004.  I also understand that if I wish to cancel my tour, the Terms and Conditions as stated in brochure will apply and be enforced. I am aware that I am responsible for adequate personal and medical insurance. (Please note that Heavenly Tours will be unable to proceed with your reservation without your signature on this form.)

SIGNED: ___________________________________ DATE______________

Make check payable to: Heavenly International Tours

Mail this form with your deposit to:

HEAVENLY INTERNATIONAL TOURS
3900 W. Brown Deer Rd. - Suite A134
Milwaukee, WI  53209

  (800) 322-8622 or (414) 352-6522