<p>CHRISTINA COOKS TUSCANY RESERVATION REQUEST FORM JUNE 24 THROUGH JULY 1, 2017</p><p>Name as it appears on passport ______</p><p>Passport number ______Date of Birth ______</p><p>Name as it appears on passport ______</p><p>Passport number ______Date of Birth ______</p><p>Address ______</p><p>City______State ______Zip______</p><p>Phone No (day) ______(eve) ______</p><p>Email ______</p><p>Emergency contact information (name) ______</p><p>Emergency contact information (phone) ______(email) ______Payment ($3,595.00 per person double occupancy / $4,345.00 single occupancy) Tuscany 2017 prices do not include air. Depart USA Friday, June 23, 2017, arrive Rome - Airport FCO –Saturday, June 24, 2017. Return USA July 1, 2017. Extend trip on front or backend, and or fly in and out of different airport than FCO – call or email Robert at 1-800-939-3909 (office) / 215-850-3656 (cell) / [email protected] for info. We will assist with all arrangements. Deposit ($1,000.00 per person due with reservation)  Check or money order payable to Christina’s Choice LLC ($1,000.00 per person) enclosed  Charge credit card ($1,000.00 per person)  VISA  MC  AMX  DIS Final Payment due May 11, 2017 (45 days prior to first day of trip)</p><p>Credit card no.______Exp. Date ______SEC Code ______</p><p>Signature ______Date ______</p><p>Room Information  Double  Single (additional cost applies)  Family rooming together No. in Party _____</p><p> I am sharing a rooming with______ I am interested in sharing a room, please call me</p><p>Please read other side for important information regarding cancellation policy, disclaimer and trip insurance Mail, email or fax completed form to: Christina’s Choice, LLC, 243 Dickinson St, Philadelphia, PA 19147-6003 215-551-1430/1-800-939-3909/fax 215-551-9498/e-mail [email protected]</p><p>Cancellation Policy Full refund of deposit, less $150.00 per person processing fee, with 60-day written notice. Cancellation 60-days to 30-days in advance, 50% refund of deposit, less $100.00 per person processing fee. Cancellations within 30-day period prior to first day of trip will forfeit full cost of trip. </p><p>Exception Policy If canceled room is resold at any time prior to trip, full refund, less $100.00 per person processing fee, will be issued within 30-days of last day of trip.</p><p>Disclaimer Christina and Robert Pirello, and their affiliated companies, (Macro Tours, Christina Cooks and Christina’s Choice, LLC), acts only as an agent for various independent suppliers that provide hotel accommodations, transportation, sightseeing, activities, or other services connected with these tours. Such services are subject to the terms and conditions of those suppliers. Christina and Robert Pirello and their respective employees, agents, representatives, and assigns accept no liability whatsoever for any injury, damage, loss, accident, delay, or any other incident which may be caused by the negligence, defect, default of any company or person in performing these services. Responsibility is not accepted for losses, injury, damages or expenses of any kind due to sickness, weather, strikes, hostilities, wars, terrorist acts, acts of nature, local laws or other such causes. All services and accommodations are subject to the laws and regulations of the country in which they are provided. Christina and Robert Pirello and their affiliated companies are not responsible for any baggage or personal effects of any individual participating in the tours/trips arranged by Christina’s Choice LLC. Individual travelers are responsible for purchasing a travel insurance policy if desired that will cover some, or all of the expenses associated with self-initiated trip cancellation, the loss of luggage or personal effects. </p><p>Trip Insurance Reasonably priced travel insurance, and self-initiated trip cancellation insurance due to health or other acceptable emergencies is available through Allianz Travel Insurance. If you choose to purchase travel insurance on your own, you can sign up on line at www.accessamerica.com or by calling: 1-866-672-9580.</p><p>We recommend making a copy of this form for your records</p>