Montmartre Enrollment Form

Montmartre Enrollment Form

AT HOME IN MONTMARTRE 2012

PARTICIPANT INFORMATION

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NAME AS IT APPEARS ON YOUR PASSPORT

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ADDRESS

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CITY, STATE, ZIP CODE

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HOME PHONE, CELL NUMBER, EMAIL ADDRESS

I am enrolling in the ___March 25-April 1 __ April 15 -22 tour

I am requesting: (single occupancy) (double occupancy*)

with (Please submit a separate enrollment form for each participant in Double Occupancy, except for married couples) _________________________

MY CHECK for $1,000 per person made payable to Chez Madelaine is enclosed.

Please mail to 425 Woodside Ave., Hinsdale, IL 60521.

I WISH TO CHARGE a $1,000 deposit (per person)

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CARD NUMBER - EXPIRATION DATE - SECURITY CODE

(A 4% charge will be added to cover processing fees for VISA/MASTERCARD

My SIGNATURE indicates that I have read and agree to all of the following Terms and Conditions of this travel program.

________________________________________________________
SIGNATURE / DATE

Direct questions to Madelaine by telephone: 630-514-8712 or email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

* Touring Companions are welcome to come for all trip activities except the cooking classes and accompanying lunches at the reduced rate of $1000. $500 is to be paid as a deposit and the balance is due a month before the trip.

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NAME AND ADDRESS