Reservation Form for Discover Pu’er 2016
Please print this form, fill out and mail to Fusion Pacific Ltd. 158 Oxford St. Winnipeg MB, R3M 3J5, Canada or email to: nan.cui@teajourney.pub
Name #1 (as on passport): ______________________________ Date of Birth: _________________________
Name #2 (as on passport): ______________________________ Date of Birth: _________________________
Passport #1: __________________________ Expiry Date: ________________ Country : ________________
Passport #2: __________________________ Expiry Date: ________________ Country : ________________
Address: _____________________________________________________________________________
Address: _____________________________________________________________________________
City, State/Province, Postal Code: ____________________________________________________________
Home Phone: __________________ Work Phone: ___________________ Mobile: ____________________
Email address(es): ______________________________________________________________________
I will be joining the (please check all that apply): ☐Pre tour ☐Base tour ☐Post tour
Single room requirment: ☐ I would like a single room
I have read the information in the Tea Journey brochure/website for the tour and agree to its terms.
Signature: ________________________________________ Date: _________________
Signature: ________________________________________ Date: _________________
