Synergy Tours Registration Form

Please print, fill out and mail with your check or fax your information.

Names must be printed as they appear on your Passport, when flights are included.

You will also need to send us a copy of your passport, which will be returned to you.

1^st Name ________________________________________________ D.O.B. _________

Address _______________________________________________________________

City                                           State        Zip                  Phone ___________________

2^nd Name ________________________________________________ D.O.B. __________

Address _______________________________________________________________

City                                           State        Zip                  Phone ___________________

 Save a stamp, save a tree, write down your email for me!

Email : ___________________________________________

Special request/needs: ___________________________________________________

_____________________________________________________________________

Name of Tour or Cruise: ____________________________________________

Dates: ____________________ Room or Cabin type:_____________________

Synergy Tours accepts Visa, MasterCard for payments over $500 per person. We require the card holders’ signature authorizing Synergy Tours or said supplier to charge your credit card for payment.

I agree to Synergy Tours & Cruises terms and conditions

and by checking this box # do authorize the charges to my credit card.

Name on card: ______________________________ Signature: _____________________________

2320 East Baseline Rd. Ste.148- 468 Phoenix, Arizona 85042-6951

Phone: 602-276-9008, Fax: 480-626-0630, Email: mike@synergytours.com

After we receive this signed form, we will call you for your credit card information!