Celtic Quilt Tours, LLC

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1 , LLC TRAVELLER PROFILE FORM Agency Name:, LLC. September 19 - October 1, 2016 Booking number or requested trip: 2016 Kilts & Quilts Textile Tour of Scotland Kim Caskey (CANADA) Debbi Cagney (USA) kim@kimcaskey.ca; debbi@debcagney.com; Name: *exactly as appears on your passport Roommate: First middle last Preferred Name for Name Tag: Date of Birth: Passport #: Expiry date: dd-mmm-yy dd-mmm-yy Address: street, city, province/state, postal code/zip code Phone #: Credit Card #: Expiry date: address: Cardholder Name: CVC: Card Address If different than above: Air Travel Details: US/Canada Departure: Scotland Departure: Registration Date: Tour Host:

2 Scotland 2016 page 2 Traveller: Please provide as much information as possible, so that every effort to accommodate your special needs can be made. All disabled clients must be accompanied with an able bodied companion. Passengers with wheelchairs must bring their own collapsible wheelchair. Motorized wheelchairs are not permissible. 1. Please describe the nature of the disability/medical special need, or indicate NONE: 2. Will you be travelling with any special equipment? (eg. wheelchair, walking stick, medically necessary device, etc.) Oxygen must be arranged through a professional supplier. If yes, please give details such as dimensions of wheelchair, weight, etc. 3. Are you able to walk/climb stairs unaided (including steps on/off the motor coach), numerous times per day)? 4. Name of travelling companion (aid) who will be accompanying you (if applicable): 5. Is your companion (aid) able to provide all assistance you will require throughout the tour (such as boarding the motor coach, climbing steps, accessing local hotel lobbies, etc.)? 6. Are there any other details/dietary needs we should be aware of to better assist you? 7. If you will you be taking any prescription medication while on tour, please supply (on separate sheet) a complete list, including medication name, dosage, refrigeration, etc. 8. Emergency contact names and phone numbers (not travelling with you): Name phone number Relationship Name phone number relationship Signature of passenger: Date: Companion signature: Date: NOTE: Journeys Connect will make every reasonable effort to accommodate the special needs of our passengers, but we are not responsible for any denial of special services by airlines, hotels, lodges, restaurants, other suppliers or any additional fees charged for assistance. Escorted tours adhere to a pre-determined and unalterable timetable in conjunction with timescheduled services provided by overseas operators. The undersigned hereby indicates understanding and agreement with to these conditions. This form must be approved by Journeys Connect prior to accepting your deposit.

3 Scotland 2016 page 3 Payment Details All purchases made through Journeys Connect are in US$, processed through credit card. Land Tour package and Group Air travel fees are separate, in order to accommodate those travelers wishing to make their own air travel arrangements. Group Air travel fees will be announced. Deposit/Payment Requirements: Initial Deposit: $200 per person is required to reserve space. Full and final payment of Land Tour (+single supplement) is due by May 1, 2016, with payment options as indicated below. Purchases will be charged to the credit card on file. Cancellations/Changes: Deposits and payments are non-refundable. We strongly recommend purchase of Trip Cancellation Insurance. For full coverage details, please visit: Trip Cancellation Insurance Premium: The premium (fee) for trip cancellation insurance is calculated at 8% of the total purchase. This premium is collected at time of initial deposit and charged once the minimum 25 participants have been reached. The insurance premium is in addition to the payment schedule. Terms and Conditions: This is a private group journey, based on a minimum of 25 participants to operate. Rates quoted are in US$, per person based on double occupancy. Single supplement is an additional $620. Hotels are subject to change. Depending on weather conditions and circumstances beyond our control, the itinerary is subject to change. Optional Group Air: Departure taxes and fuel surcharges are included in the optional group air. Optional air rates are subject to availability and are based on a minimum of 10 passengers and departure from either USA or Edmonton International on IcelandAir. Group air may not be eligible for accrual of frequent flyer points/mileage and seating preferences requested are not guaranteed. Group airfares are non-refundable. For a full list of terms and conditions, please visit: Traveller Name (please print) Date Traveller Signature

4 Scotland 2016 page 4 Please indicate your purchase preference below (X): Traveler Purchase Details: $2999 Scotland ONLY Land Tour (dbl. occ. ) $639 Iceland Post-Tour (dbl occ) $899 Single Supplement $280 Iceland Post Tour Single Supplement $YES Trip Insurance (Land Tour) $YES Trip Insurance (combined) Trip Insurance Premiums: Calculated at 8% of total trip cost; payable at time of deposit* $ Scotland ONLY Land Tour (dbl. occ.) $ Scotland & Iceland Post-Tour (dbl. occ.) $ Scotland ONLY Land Tour - Single Supplement *Will be charged when tour reaches 25 travelers. $ Scotland & Iceland Post Tour Single Supplement OPTION 1: Payment in Full $ Date: OPTION 2: SCOTLAND ONLY LAND TOUR (double occupancy) - Deposit + 4 payments ($2999) 1FEB16 Payment #1 $ MAR16 Payment #2 $ APR16 Payment #3 $ MAY16 Payment #4 $ TOTAL PAID $ OPTION 2A: SCOTLAND ONLY LAND TOUR (single supplement) Deposit + 4 payments ($2935) 1FEB16 Payment #1 $ MAR16 Payment #2 $ APR16 Payment #3 $ MAY16 Payment #4 $ TOTAL PAID $

5 Scotland 2016 page 5 USA OPTION 3: SCOTLAND + ICELAND POST-TOUR EXCURSION (dbl. occ.) Deposit + 4 payments ($3638) 1FEB16 Payment #1 $ MAR16 Payment #2 $ APR16 Payment #3 $ MAY16 Payment #4 $ TOTAL PAID $ USA OPTION 3A: SCOTLAND + ICELAND POST-TOUR EXCURSION (sin. occ.) Deposit + 4 payments ($4565) 1FEB16 Payment #1 $ MAR16 Payment #2 $ APR16 Payment #3 $ MAY16 Payment #4 $ TOTAL PAID $

Celtic Quilt Tours, LLC.

Celtic Quilt Tours, LLC. , LLC TRAVELER REGISTRATION FORM, LLC. 2019 Quilt Shop and Textile Tour of Ireland Worldwide Quilt & Textile Tours June 3 14, 2019 Kim Caskey (CANADA) Debbi Cagney (USA) kim@kimcaskey.ca; 780-288-9008