G.A.P. Booking Form - Please read TERMS & CONDITIONS

Attn: Jackie Garrity - G.A.P. Land Contact
G.A.P Adventures - 355 Eglinton Ave. East, Toronto, ON, Canada M4P 1M5
Telephone: 416 260 0999 x 105, FAX: 416-260-1888

LAND BOOKING FORM - Please complete in full for all travelers.
(Private information below. Information only to be used for Christa's Belize Trip.)

TRIP: CHRISTA'S BELIZE TRIP DEPARTURE DATE: Friday, JAN. 28, 2005

The correct spelling of your Passport Name is required on this form if different from your daily name.

Put your daily name in these brackets. (________________________________________________).

Please print: (If paying by cheque please also write your passport name on your cheque.)

FULL NAME ON PASSPORT - _______________________________________________________

ADDRESS__________________________________________________________________________

SUITE_____________________________________________________________________________

CITY ________________PROVINCE/STATE _____________

POSTAL/ZIP CODE__________________________________

TEL: WORK________________________________HOME__________________________________

FAX: ______________________________________

EMAIL: ____________________________________________________________________________

SEX: M F DATE OF BIRTH: (MM)________ / (DD)________ / (YE)________

NATIONALITY ______________________PASSPORT NO._________________________________

PASSPORT EXPIRATION.____________________________________________________________

OCCUPATION________________________________________________________________

SPECIAL MEDICAL/DIETARY NEEDS____________________________________________

EMERGENCY CONTACT_______________________________________________________

TEL:_________________________________________________________________________

CREDIT CARD PAYMENTS:
Please be advised that credit cards will only be accepted for deposit, insurance and some flights.
(Note: We can pay our trip balance by credit card as well & no extra % will be charged)

Please charge $____________on my: Visa Master Card American Express
as a deposit.

Card Number _______________________________________________Expiry Date________

As one of the names above and on behalf of all persons listed, I have printed, downloaded and read the terms and conditions and accept and understand that they form part of this contract. I undertake on my own behalf and on behalf of any other persons for whom this is a joint booking to accept the terms and conditions of G.A.P Adventures and the decisions of the trip leaders they appoint. I also understand that I am booking on an adventure holiday and standards such as; accommodations, transport, medical service and other factors will not be of the same standard that I/we are used to at home, or that might be found on a conventional holiday.

Please answer the below with a check mark:
I have read and agree with the above statement.
I, and/or my travelling party, understand that travel medical insurance covering personal accident,
      emergency evacuation and repatriation expenses is mandatory on all G.A.P Adventures please check.
I, and/or my travelling party, am already covered by my own insurance provider.
I, and/or my travelling party, would like to purchase travel medical insurance through
       G.A.P Adventures.

Cancellation insurance while not obligatory, is strongly recommended by G.A.P.
I, and/or my travelling party, would like to purchase cancellation insurance with G.A.P Adventures.

Signature________________________________________________Date: ________________

G.A.P. Terms & Conditions

TICO registration number is 4483475.