Please note that for certain travel within Vietnam, such as over night on Halong Bay, the tourist authority requires we forward personal information in advance. Other personal information gathered here is for medical and evacuation insurance, which is typically included in all of our tours.

Name 1: (as it appears on passport) : ____________________________________________

Name 2: _______________________________________________________________________

Address: _______________________________________________________________________

City/Ville: _____________________   State/Province: ____________ Country: _______

Postal Code: __________________

Telephone (h): _________________        Telephone (w): _____________________

E-mail:  _______________________      (e-mail is a good way to contact me Yes   No)

Date of Birth:  ___________________      Occupation:_______________________________

Passport Number(s): ________________________  Expiration Date*:________________

Emergency Contact 1: _______________________ Telephone: _____________________

Emergency Contact 2: _______________________ Telephone: _____________________

* Must be valid for SIX months after arrival in-country.

 Please check all that apply

 Provide assistance and/or recommendations for international airlines.

 Send me a quote for trip cancellation insurance.

 I already have booked my international flights, details to be forwarded to ITC.

 I would like a single room (extra fees apply)  Please arrange a roommate for me

 I am sharing a room with ___________________ Type of bed: Double Twin

 I have special requests: ___________________________________________

 I require Internet access  I would like to rent an international mobile phone

I will need additional hotel arrangements for city & dates:

Dates: __________________________City: _______________________________

Dates: __________________________City: _______________________________

- Previous travel experiences similar to this trip:

- Health or diet concerns we should know about (e.g. strict vegetarian)?

- Additional detail: is there anything else we should know about you (e.g. will it be your birthday,   Honeymoon, anniversary, are you a veteran wanting to visit a certain place)?

- How did you find out about us?

Arrangements for your tour incur expenses well before your departure, such as airline and hotel bookings. If you need to cancel your trip, please do so in writing (email and faxes are acceptable). For a cancellation more than 60 days prior to departure, a full refund minus a $500 non-refundable deposit will be made. If you are on a scheduled group tour and we are able to resell your space, deposit will be refunded.For cancellation made within 60 days prior to departure and Indochina Travel is able to fill your space, full fees will be refunded minus the $500 non-refundable deposit per person. If no replacement is found, refund will be subject to our cancellation schedule (below). In the event of trip cancellation by Indochina Travel, a full refund will be issued.

I understand the balance of tour fees are due 60 days prior to departure and my tour may be cancelled for delayed payment without prior notification. Additionally, Indochina Travel requires that you have trip cancellation insurance.

Unless agreed upon in writing, no refund will be made for unused services or activities on tour, including unused accommodation, meals, transportation, or other services. Indochina Travel and its representatives shall not be responsible for any expenses or liability resulting from labor disputes, governmental or official actions, weather conditions, sickness, or any other cause beyond our control. If necessary, Indochina Travel also reserves the right to alter, cancel or substitute tour arrangements, services and/or activities without prior notification or provision for refund.

Liability Waiver
I, the undersigned, understand and agree that Indochina Travel and its representatives do not accept any liability for any injury, loss, accident, delay, or damage to or in respect to any person participating in their tours. Although Indochina Travel provides emergency medical services and air evacuation insurance on tours within Vietnam, Indochina Travel in no way assumes responsibility for their services. This coverage is only good for travel within Vietnam (and evacuation to Singapore), INDOCHINA TRAVEL STRONGLY URGES YOU TO PURCHASE A SUPPLEMENTAL MEDICAL PLAN as well as cancellation and baggage insurance for your trip.

Signature:________________________________ Date:___________________

I understand Indochina Travel does not offer and requires that I have trip cancellation insurance. I acknowledge I have, or will arrange, such coverage previous to my departure. Initial _______

I authorize the following charges marked below to be billed to my credit card:

Deposit of five hundred dollars (US$500) for each person AND/OR

Balance or other fees, totaling: US$___________ (due 60 days before departure)

Credit Card Type:  AMEX   MasterCard  VISA

Card Number #____________________________________________________ Exp. Date:_____________

Name on Credit Card:___________________________________________________

 Address:  _____________________________________

                _____________________________________

                _____________________________________

 Billing Telephone: ( ____ ) -____________________________

Authorized Signature:__________________________________ Date: ______________