To be assured of reservations, please complete and mail this registration form to:
Jim & Loretta Church, PO Box 183, 1035 Valley Road, Telford, PA 18969.

Enclosed is my deposit check of $1000 per person, or $1350 per person with insurance.
Please make check payable to MTS TRAVEL.

(Please Print - name(s) as they appear in passport)

Name 1: ___________________________________________________________________

Name 2: ___________________________________________________________________

Address ___________________________________________________

City, State, Zip ______________________________________________

Phone(evenings) _____________________(day) _____________________ Fax _____________________

E-Mail Address _____________________________________

Room Type:  Twin/Double Single

Rooming with: _______________________________________________________________

Check One:

 I/we wish to be covered by cancellation insurance. (Include $350 per person with your deposit check. The $350 is not refundable.)

 I/we do NOT wish to be covered by the cancellation insurance.

Credit Card Information:

 Visa  M/C  Discover American Express

Card #: ______________________________________ Exp. _______________________________

Signature:  __________________________________________________________

Please use this space if second person has a different address, OR if more than two persons are traveling from the same address.

  _______________________________________________________________________________________________

  _______________________________________________________________________________________________

OBC090210VPM CST 2013363-40 www.mtstravel.com