RESERVATION FORM

TOUR OF ANCIENT CITIES OF THE NORTHERN BLACK SEA COAST

SEPTEMBER 6 - 17, 2002

NAME______________________________________________________________________________________

ADDRESS___________________________________________________________________________________

TELEPHONE NUMBER_______________________________ PASSPORT NUMBER________________________

PASSPORT EXPIRATION DATE_______________________________________________

________I WILL STAY AT HOTELS SELECTED FOR THE TOUR
________I WANT TO STAY AT HIGHER LEVEL HOTELS

________I WILL STAY IN A DOUBLE ROOM IN A HOTEL
________I WANT TO STAY IN A SINGLE ROOM

In order to see the effectiveness of advertising:
I learned about this tour:

_______FROM A PRINT AD
_______FROM AN AD ON THE INTERNET
_______FROM MY DEALER (PLEASE SPECIFY)___________
_______OTHER (PLEASE SPECIFY)________________

SPECIAL REQUESTS __________________________________________________________________________

Please mail the completed form with your deposit check in the amount of $200 per person to Mirage Travel, 12 Neptune Ave, Brooklyn, NY 11235. Deposits are refundable in full until July 20, 2002, when the final payment is due. In order for the trip to operate, at least 8 deposits must be received by July 10, 2002.