Nomadic routes inc. Printable Trip Registration Form

For  , , Personal Cheque, or Certified Cheque please complete then print and send this form to:  

NOMADIC ROUTES INC. RR1, Site 16, Comp 8, Mayne, B.C. Canada V0N 2J0

1.  PERSONAL INFORMATION

*Your personal information and email address is used solely by Nomadic Routes Inc. for correspondence only.

It will not be sold, shared or otherwise distributed to any company or individual.

Name: 

Address: 


Phone:

Home

Work

 -  

Cell

Fax

Email

2.  PLEASE SELECT YOUR PREFERRED METHOD OF CONTACT

3.  ROUTE CHOICE:

Type in your preferred destination:

Type in your preferred activity(ies):

Type in your preferred dates:

Number of Guests Registering

4.  PAYMENT: to be completed after your tour is confirmed

Deposit of 25% or $500.00/guest which ever is greater.  Balance due 45 days prior to departure

Payment Method

Credit Card Number       Expiration Date

Signature of card holder                                                                                                                          

Print name of card holder 

5.  HOW DID YOU LEARN OF NOMADIC ROUTES?             

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