Please provide accurate information. This will eliminate any change fees or document delays.
GroupName: Travel Club at Twin Mills of Lake Norman
GroupCode: G6-30214
Trip: Jewels of the Sicilian Coast: Palermo, Siracusa & Mount Etna DepartureDate: 2/15/26
OptionalPreTripValleD'ItriaDepartingon2/10/26Y_No_
OptionalPostTripTuscanyDepartingon3/8/26Y_No_ WillyoubetakingairwithGCT?Y_No_Ifyes,DepartureCity: CabinCategories{Top3choicesex.A,G,F)(NOCABINNUMBERS):1. ____J 2&3.
Address: _______________________________
City : _______________ State: _____ Zip: ____
Phone (primary): ___
Full name (as it appears on your passport):
Title:
Nickname (for name badge): _ _
Passport#: ________ _ (passports must be valid for 6 months after the trips ends. May 2026)
(secondary):
Passenger2 (only if at same address as above)
Full name (as it appears on your passport):
Title: First: _________ _ _ Middle: ______________ Last: _______________
Nickname (for name badge): _______
Passport#: ________ _ (passports must be valid for 6 months after the trips ends. May 2026)
Passport Exp. Date: __ / __ / _ _ _ _ Passport Exp. Date: __ / __ / ___ _ MM DD YEAR MM DD YEAR
Date of Birth: __ / _ _J ____ Date of Birth: __ / _ _J ___ _ MMDDYEAR MMDDYEAR
Place of Birth:_ _________ Place of Birth: ___________
Nationality: ____ Nationality : _________ _ _ Occupation:____________ Occupation : ____________ Dietary Restrictions: Dietary Restrictions:
Emergency Contact: _______________________________
Phone Number: _________ _ Secondary Number: _________ _
----------
Will you be sharing accommodations with someone? Yes _ No Name:
Optional Travel Insurance with Trip Mate? Yes_ No_
Please put your air preferences below (EX. Business Class, Premium Economy or Airline Preference) *based on availability.
KTN # (TSA Pre or Global Entry): ______________ Expiration Date: ______
Frequent Flier# 1: ____ _ Airline: ____________
Frequent Flier # 2: Airline: ____________
PaymentInformation: (A deposit of $750 per person is required at the time of booking. Final payment is due 90 days prior to departure.)
Check (takes 7-10 business day to post): Please make payable to GrandCircleTravel
Electronic Transfer (payment is automatic): Name on Checking Account: __________________
Routing Number: ________ _ Account Number: ____ _________
Taking Good Buy Discount Yes_ No_ (See flyer for more details. N/A with credit cards)
Credit Card: Master Card Visa _ Discover (American Express NOT excepted) Card#: _______________ Exp. Date : __ / __ MM YEAR CW Code: ____
Card Holder name: _____________________ Signature: _____________________ Date:_/_/ ___
SunDeck
VerandaDeck
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