REGISTRATION FORM

Hebraic Roots Tour to Israel
Date of Tour: October 10th to 19th, 2010
$2,899 + Airport Tax

Please Complete a Separate Form for Each Person

Last Name: _____________________________________________________________________________

First Name (as it appears on your passport): __________________________________________________

Preferred Name: _________________________________________________________________________

Citizenship: _____________________________________________________________________________

Passport Number: _______________________________________________________________________

Home Mailing Address: ___________________________________________________________________

City: _______________________________ Province: __________ Postal Code: _____________________

Telephone Number: Home: (_______) _______ - _________ Business: (_______) _______ - _________

ROOM OPTIONS:

I wish to have a room to myself at the cost of $699: r Yes r No

OR I wish to share a room with: ____________________________________________________________

INSURANCE:

I will purchase my own insurance: r Yes r No

OR I would like to purchase insurance from International Heritage Tours. Please circle one of the options below.

Sharing double room

Sharing double room

Rates single rooms

Rates single rooms

Rates for All Inclusive Insurance with: Trip Cancellation, medical, trip interruption, lost baggage, etc.

Rates for Semi Inclusive Insurance with: Trip Cancellation, (no medical) Trip Interruption, lost baggage etc.
Rates for All- Inclusive Insurance with: Trip Cancellation, medical, Trip Interruption, lost baggage etc.

Rates for Semi Inclusive Insurance with: Trip Cancellation, (no medical), Trip Interruption, lost baggage etc.

Up to 59 years: $150
60-64 years: $183
65-69 years: $241
70-74 years: $338
75-79 years: $417
80-84 years: $537

Up to 59 years: $128
60-64 years: $141
65-69 years: $163
70-74 years: $184
75-79 years: $321
80-84 years: $405

To age 59 years: $175
60-64 years: $213
65-69 years: $279
70-74 years: $384
75-79 years: $485
80-84 years: $620

To age 59 years: $152
60-64 years: $171
65-69 years: $202
70-74 years: $229
75-79 years: $381
80-84 years: $473

PAYMENT:

I enclose my payment of r $300.00 Deposit OR r Full Payment of $__________ PLUS $________ for Insurance

We require a deposit of $300 per person refundable 90 days before departure (less a $100 administration fee) and full payment 60 days before departure. An additional 2% applies to credit card charges. Please make cheques payable to "International Heritage Tours".

Please Mail Cheque to:
INTERNATIONAL HERITAGE TOURS
7117 Bathurst Street Suite 200 – Thornhill, ON – L4J 2J6 — 1-877-999-8868 – Ari Bauer at ext. 415