Ormond Memorial Art Museum & Gardens
Provence Tour Reservation
 Mail form to Focus Travel, 420 N. Halifax Ave, Ste 2, Daytona Beach, FL 32118
Questions? Call (386) 258-3443 ask for Judy Eberhardt
 
Name(s)
(as they appear on passports)  		 1.

2.
Address    
City, State, Zip  

_____________________________________
City

____
State

________
Zip
Telephone   Number   

(            ) ________ - ___________________
 Area Code
Fax Number   

(            ) ________ - ___________________
 Area Code
Name of Roommate (if sharing)

 

Number of Applicants  ______  X $800 deposit per person = Total  Due $_______

Enclosed is my check number

________

in the amount

$____________________

Bill my credit    
card:   

   O MasterCard   O Visa   O American Express

Card Number:   

  __________-__________-_________-_________-_________

Expiration Date:   

  ____________ / ____________ (Month / Year)

Name as it    
 appears    
on card:    

 ____________________________________________ (Please Print)

Signature:   

  _____________________________________________________

Mail form to Focus Travel, 420 N. Halifax Ave, Ste 2, Daytona Beach, FL 32118
Questions? Call (386) 258-3433 ask for Judy Eberhardt
OMAM is a U.S. Code Title 26 Section 501(c)(3) non-profit organization,
registered with the State of Florida Department of Agriculture and Consumer Services.
Registration Number: SC07333.
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This web page was updated on 15-Apr-2007 10:33 AM -0500