CROSSING LATITUDES  RESERVATION FORM   

To reserve your space mail, fax or call in this information with your $500.00 non-refundable deposit to:
Crossing Latitudes, Inc., 420 W. Koch, Bozeman, MT 59715 USA. Phone: 1-800-572-8747,
Fax: (406)-585-5356, email: info@crossinglatitudes.com.
A separate reservation form must be filled out for each participant. Feel free to make additional copies of this form.

Name of Trip: ________________________________________Departure Date: __________________

Your Name:________________________________________

Address:________________________________________

_______________________________________________


Phone (day):_______________________     Phone (eve):_______________________ 

Email Address: __________________________

Birthdate:    /    /    Gender: ___________ Citizenship:_______________________ 

Emergency Contact: Name, Relation, Address & Phone#: ____________________________

____________________________________________________________________________


I have read and agree to the Terms and Conditions as outlined by Crossing Latitudes, Inc. Be sure to sign and date the reverse side of this form.

Signature:______________________________________________  Date:_______________________ 

Enclosed is my/our payment in the amount of $_______________ ($500.00 non-refundable deposit per person). Please make checks payable to Crossing Latitudes, Inc. or complete the Visa / MasterCard credit card information below.
You can call in credit card information: 1-800-572-8747

Your remaining balance and your signed forms are due 60 days prior to trip starting date. The balance must be paid by check.

Charge to: Visa Master Card                    Number: ______________________________________________ 

Expiration Date:    /    /        Name as it appears on card:____________________________________________ 

Signature as it appears on card:_____________________________________________ 

How did you first learn about Crossing Latitudes? ____________________________________________


If you have not already received the following: Terms and Conditions, Trip Itinerary, Equipment List, Medical Form, Travel Guard Insurance pamphlet and Travel Information please call and we will send them immediately. Thank You.


A separate reservation form must be filled out for each participant. Feel free to make additional copies .