Join us on a Wine Tour of Tuscany          with Dick Vermeil
May 13-23, 2019

~Registration Form~

A deposit of $500 per person is required to hold your reservation.

Final payment due on or before 2/4/19. No refunds after final payment.

Full Legal Name *
Full Legal Name
Must match your Passport. If you have a middle name please include it on the line with your first name.
Birth Date *
Birth Date
Passport Issue Date *
Passport Issue Date
Passport Expiration Date *
Passport Expiration Date
Room Mate Name (Must match Passport)
Room Mate Name (Must match Passport)
Room Mate Birth Date
Room Mate Birth Date
Room Mate Passport Issue Date
Room Mate Passport Issue Date
Room Mate Passport Expiration Date
Room Mate Passport Expiration Date
Address *
Address
Phone Number *
Phone Number
You will be invoiced for your deposit. If you choose to pay by credit cards 4% service fee will be added.