reservation Form

TOUR RESERVATION FORM
July 1-12, 2005

Mail your deposit to:
NANCY L. NEWFIELD
Casa Colibrí
3016 45th Street
Metairie, LA 70001
Ph: 504-835-3882

Please enter my reservation for ______ person(s) on the HummerQuest 2005 Costa Rica Tour with Nancy L. Newfield. Enclosed is my check in the amount of $__________ representing $300.00 per person deposit. Balance of $2000.00 per participant is due by early May 2005.

NAME: _______________________________________________________________

ADDRESS: ____________________________________________________________

CITY/STATE/ZIP: ______________________________________________________

TELEPHONE:

home (_____)___________________

office (_____)___________________

E-MAIL ADDRESS: ____________________________________________________

ACCOMODATION REQUEST (Check One)
( ) I will be rooming with:
( ) Please assign roommate.
( ) Please reserve a single room. ($220.00 single supplement fee)

In case of emergency, please notify:

SIGNATURE: _______________________________________________

DATE:____________ (mm/dd/yyyy)

NOTE: Your signature and deposit denote acceptance of the conditions and terms set forth for the HummerQuest 2005 Tour: July 1-12, 2005.