Machu Picchu & The Galapagos Islands Form

Please fill out and return

TOUR: Machu Picchu & the Galapagos Islands

DEPARTURE DATE: Apr 17, 2018

GROUP NAME: Lifestyle Tours


Available Prepaid Options

Personalize your tour by adding an optional activity below. Our recommended options have been carefully chosen to help enhance your individual experience. Complete the provided Prepaid Options Form to reserve your options.

Availability is limited and reservations are on a first come, first served basis. Payment must be received no later than 15 days prior to departure. Prices are subject to change. Children under the age of 18 MUST be accompanied by an adult.

PASSENGERS NAME: (Please submit a separate form for each passenger)

Salutation:____ First:___________________ Middle:_________________ Last:______________________ Suffix:____ Nickname:_____________

(Mr., Mrs., Rev.) ( Please print EXACTLY as it appears on Passport) (Jr., Sr.)


Price Per Person

Mystical Shaman Ceremony- 4/21/2018

Please note a maximum of 15 passengers is allowed for this option. No transportation required as this option is done indoors at the hotel.


Cuzco through the Senses- 4/23/2018


History, Food and Culture of Quito- 5/1/2018


travel date: 4/17/2018 territory: M6

Machu Picchu & the Galapagos Islands

RES#: 797034

For Reservations Contact: Tracy Wilson or Ken Meyer (812) 682-4477 email:

Lifestyle Tours, 700 State Route 269, New Harmony, IN 47631-9517

A deposit of $750 per person is due upon reservation. If you purchase our Travel Protection Plan, the deposit is only $500 per person plus the cost of the Insurance. A second deposit of $2,590 per person is due September 11, 2017. Reservations are made on a first come, first served basis. Reservations made after the deposit due date of September 11, 2017 are based upon availability. Final payment due by December 18, 2017. Deposits are refundable up until September 18, 2017.

YOUR INFORMATION: Clearly print your full name (first/middle/last) as it appears on your government issued travel documentation. We strongly recommend that you have a valid passport with 6 months validity after the tour return date for all travel outside the United States.

IMPORTANT: In order to avoid any unnecessary change fees, it is imperative that all guest names are entered correctly from the start. The information below must be the legal name and be 100% identical to the ID being used to travel <passport/driver’s license> including middle names or suffixes <Jr, Sr>.

First: Middle or Initial: Last: Suffix:

Nickname: Gender: ( ) Male ( ) Female Date of Birth: month day year

Address: City: State: Zip Code:

Phone: ( ) Cell: ( ) Email Address:

Passport Number: Expiration Date: (month/day/year) Date of Issuance: (month/day/year)

City, State, Country of Issuance: Citizenship:

Should you become ill or injured, whom should we contact (not traveling with you): Phone: ( )

ROOMING WITH: £ Check if address is the same as Passenger #1

First: Middle: Last: Suffix:

AIR GATEWAY: Departure airport for this tour:

Air Seat Request: ( ) Aisle ( ) Window ( ) Next To Traveling Companion

Collette cannot guarantee your seat preference. If you have not purchased air through Collette and wish to purchase transfers, you must transfer at our pre-scheduled times.

Please be advised, when travelling as part of a group, many airlines do not provide seat assignments. Preferred seating may be available for an additional charge.

Please reserve an upgrade to Elite Airfare for an additional rate of: £ Business Class $3,290
Service is limited and not available on all flights or carriers. Other restrictions may apply. Please note: if you purchase an upgrade we cannot guarantee the same flight schedule as the group. Are you willing to separate from the group air schedule to accommodate your upgrade request? ( ) Yes ( ) No
“Federal law forbids carriage of hazardous materials such as aerosols, fireworks, lithium batteries & flammable liquids aboard the aircraft in your checked or carry-on baggage. A violation can result in 5 years’ imprisonment and penalties of $250,000 or more. Details on prohibited items may be found on TSA’s “prohibited items” web page:”

Travel protection: ( ) Yes, I wish to purchase travel protection $350 ( ) No, I decline

If you choose not to purchase Collette's Waiver Insurance Plan, you will incur penalties for changes and cancellations. Travel Protection Payment is due with first deposit. The Waiver Fee does not cover any single supplement charges which arise from an individual’s traveling companion electing to cancel for any reason prior to departure. The single supplement will be deducted from the refund of the person who cancels. (There is coverage under Part B which includes a single supplement benefit of $1,000 for certain covered reasons. See Part B for details.)

EXTENSION: I wish to purchase "3-Night Otavalo" ( ) Yes ( ) No

CABIN PREFERENCE: Please Number Your Choices from 1 to 3. (1 being your top choice)

( ) Balcony ( ) Junior Suite ( ) SuperiorWe will make every effort to accommodate your cabin category preference at the time of booking. It is suggested that you indicate your first, second and third choice of cabin categories. If requested cabin category is not available, the next available category will be offered and the supplemental amount will be added or deducted.

ON TOUR ACTIVITIES: Please choose one of the following on tour activities

( ) Coach Tour of Cuzco( ) Walking Tour of Cuzco

PLEASE MAKE CHECKS PAYABLE TO: Lifestyle Tours ( ) Check ( ) Credit Card

Waiver/Insurance Amount: $___________________ Deposit Amount: $___________________ Total amount enclosed: $___________________

Cardholder Name (if paying by Credit Card):

Cardholder Billing Address: £ Check if address is the same as above

Cardholder Phone: Amount: $

Credit Card Number: ________________ Expiration Date:____


Signature Required for acceptance of the below conditions and agreement to credit card use:


I agree to pay according to the card issuer agreement. I understand and accept the cancellation policy, terms and conditions. See for full terms and conditions of your purchase. Important Conditions: Your price is subject to increase prior to the time you make full payment. Your price is not subject to increase after you make full payment, except for charges resulting from increases in government-imposed taxes or fees.

162 Middle Street

Pawtucket, RI • 02860

Phone: 1-800-852-5655 Fax: 1-401-727-9014

If paying by credit card, please complete this form and return to Lifestyle Tours. We can only charge your credit card for the amount noted if the signature, address and phone number are listed below. Thank you!



TOUR: Machu Picchu & the Galapagos Islands

DEPARTURE DATE: April 17, 2018

GROUP NAME: Lifestyle Tours

Name of Passenger:

Salutation:______ First Name:__________________ Middle Initial:____ Last Name:_________________ Suffix:____

(Mr., Mrs., Rev.) (Please print as it appears on Passport) (Jr., Sr.)

Cardholder Name: _________________________________________________________________

(Please print as it appears on your Credit Card)

Cardholder Address: _______________________________________________________________

(as it appears on your credit card statement)


Cardholder Phone: _________________________________________________________________

Credit Card Type:

___American Express ___Discover ___MasterCard ___Visa

Credit Card Number: _______________________________________________________________

Expiration Date: ___________________________ Amount to be charged: $ ___________________

Cardholder’s Signature: ____________________________________ Date: ___________________

I agree to pay according to the card issuer agreement. I understand and accept Collette cancellation policy, terms and conditions.

Participating credit card companies are now requiring a billing address and phone number for FRAUD PREVENTION. All information MUST be provided. Thank you for your cooperation!

If using your credit card for payment, please return this Authorization Form by mail to:

Lifestyle Tours

Attn: Tracy Wilson or Ken Meyer

700 State Route 269

New Harmony, IN 47631-9517

Or by Fax to: (812) 682-3627

¨ Above credit card information has been called in to Collette.