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Provence Escapes Reservation Form

Before completing this reservations form, please contact us by phone or e-mail to be sure space is available. Once we have confirmed availability, please print, complete and mail this form, along with your deposit of $750 per person. The reservation form and check must be received within one week after space is confirmed.

Checks should be made payable and mailed to:
Provence Escapes, Inc.
7748 Georgetown Chase
Roswell, GA 30075

Tour Date (Select One)

2009 Tours May 23 – May 30, 2009 May 30 – June 6, 2009

Cooking Class (Please check if you would like to participate)

First Participant
Second Participant

Room Preference

(Reserved on a first-come, first-served basis)
King Beds, if available
Two Queen Beds, if available
Two Queen Beds and One Single, if available

(To be completed by each participant)

First Participant

______________________________________________________________ Name ______________________________________________________________ Street Address ______________________________________________________________ City                                                              State                            Zip ______________________________________________________________ Passport Number                                          DOB

____________________ Home Phone

____________________ Work Phone

___________________ Cell Phone

______________________________________________________________ Email Address

______________________________________________________________ Dietary Restrictions / Allergies ______________________________________________________________ (Continued) ______________________________________________________________ Physical Limitations ______________________________________________________________ Emergency Contact Name ______________________________________________________________ Relationship                                           Phone

Second Participant

______________________________________________________________ Name ______________________________________________________________ Street Address ______________________________________________________________ City                                                              State                            Zip ______________________________________________________________ Passport Number                                          DOB

____________________ Home Phone

____________________ Work Phone

___________________ Cell Phone

______________________________________________________________ Email Address

______________________________________________________________ Dietary Restrictions / Allergies ______________________________________________________________ (Continued) ______________________________________________________________ Physical Limitations ______________________________________________________________ Emergency Contact Name ______________________________________________________________ Relationship                                           Phone

Deposits

A $750 per person deposit is required at the time of booking, payable within seven days of reservation confirmation. The balance is due 90 days before the first day of the tour. For tours booked less than 90 days in advance, full payment is required at the time of reservation.

Cancellations and Refunds

If we receive written notice of your cancellation 91 days or more from the start of your tour, we will refund half of your $750 deposit for each person booked. There will be no refund for cancellations made 90 days or less from the start of the tour week unless we are able to fill your place(s) with other participant(s) and unless the program has the necessary required number of participants. In this instance, we shall refund all fees received, less your $750 deposit(s). Once the week of your tour has started, no refunds will be issued for any unused portion.

Cancellation fees apply regardless of the reason. Once you have booked your trip, we strongly recommend purchasing travel insurance (including trip delay, trip interruption, trip cancellation and baggage coverage), as well as accident, medical and emergency evacuation insurance.

Responsibility and Release of Liability

There are always risks associated with travel. We strongly recommend that you purchase trip and medical/evacuation insurance. Provence Escapes, Inc., assumes no responsibility for any claim of damages, expenses or liability for any claims, injury, delay, inconvenience, irregularity, loss or damage to person or property or additional costs resulting directly or indirectly from causes that include, but are not limited to, theft, acts of government, delays, cancellations, weather, vehicle problems or accidents, strikes, illness, quarantine, acts of terrorism or “acts of God” incurred during the tour including during transportation by car, van, boat or other conveyance. Participants agree that Provence Escapes, Inc., shall not be liable, directly or indirectly, for any injury, death or damage for any reason whatsoever. Provence Escapes, Inc., reserves the right to alter an itinerary or accommodations. The company also reserves the right to cancel a tour. Should that occur, Provence Escapes, Inc.’s liability would be limited to a full refund of the reservation deposit and/or fees paid, or to offer an alternate tour date. Provence Escapes, Inc., reserves the right to decline to accept any person at any time should that person’s health, physical infirmity or mental condition impede the health, welfare or enjoyment of other participants.

I have read the conditions as stated above and agree to all terms. I also agree that the balance of the tour cost is due and payable 90 days prior to arrival.

First Participant ______________________________________________ Signature ______________________________________________ Print Name

_____________________ Date

Second Participant ______________________________________________ Signature ______________________________________________ Print Name

_____________________ Date