Tour Description – Tour Itinerary – Tour Price – General Info – Reservation Form – Tour Guide – Photos of Past Tours

Name (in full as in passport) ____________________________________________

Name preferred to be called (if different) ___________________________________

Address  ______________________   _____    __________________   _____   ______
             Street                                  Apt#      City                              State    ZIP

Day Tel ( ___ ) ____-_____ Eve Tel ( ___ ) ____-______ Email: _________________

Date of Birth ___/___/___ Occupation__________________________________

In case of emergency during the trip, please notify ____________________________

Tel( ___ ) ____-_________ Relationship to above _________________________

I would like to share a room with ________________________________________

I would prefer a single room at the additional cost as shown: YES _____ NO _____

Would you like us to arrange your flight schedule to Japan? YES ____ NO _____

Or, will you make your own flight plans to/from Narita Airport? YES ____ NO _____

If yes, plan to Arrive 11/01/10 at Tokyo, NARITA and Depart 11/14/10 from SAME

What is your point of departure? ___________________ Airline Preference? ______________

A health statement with your physician’s signature is requested prior to departure. It should be on your physician’s letterhead, showing the date of your recent examination, stating that you are in good health, and listing any current medications, known allergies, and recent or upcoming surgery. This information will be held in confidence and used only in the case of emergency.

Your signature below indicates that you have read, understand, and agree to the Terms & Conditions listed on the Quilters' Express to Japan Web site, including but not limited to the Reservation and Cancellation policy, and the request for the health statement.

SIGNATURE _______________________________________ DATE _____________

Return the completed form to Quilters’ Express to Japan along with your deposit of $300.00. Checks should be made out to Japan Travel Bureau USA, Inc. (JTB USA). To pay by credit card, photocopy the front and the back of your credit card and include a letter with your Reservation Form indicating your permission for Japan Travel Bureau USA, Inc. use of the card. Be specific as to the amount you are charging and the name and date of the tour, etc. If traveling as a couple, please submit one form per person.

Please use the back of this form for any personal information you wish to provide about yourself such as allergies, dietary restrictions, medications, etc.

Mail ALL PAYMENTS AND CORRESPONDENCES to:
Susan Ball Faeder, Quilters’ Express to Japan , P.O. Box 294, Lewisburg, PA. 17837-0294

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Updated April 2010

Tour Description – Tour Itinerary – Tour Price – General Info – Reservation Form – Tour Guide – Photos of Past Tours