Full Name * as
in your passport)
Street
Address*
City/Town*
Province
(or State)*
Postal/Zip
Code*
Country*
Home
Phone No.*
Work
Phone No.
FAX No.
E-Mail
Address*
Choose a preferred contact method:
Phone
Fax
E-mail
Rooming & Travel
Arrangements
Preferred
Rooming Arrangements (choose either A or B)
A. Please
assign me a room with this person:
B. Please
assign me :
Choose one of these rooming arrangements:
A female
roommate
A male roommate
My
own room and apply any single supplement
fees
Roommates
will be matched on the basis of age, gender and smoking
preference
If choosing to be assigned a roommate, please indicate if you
are a smoker or a non smoker
by typing YES or NO here:
If
choosing to be assigned a roommate, please indicate in
which age bracket you fall:
20's
30's
40's
50's
other
other please specify
ARCHIVAL VISITS
I wish to visit the
archives at
LVIV
IVAN FRANKIVSK
CHERNIVTSI
TERNOPIL
KYIV
Click on down arrow for your selection
Please type YES or No
for your Archive visit:
I
will need a translator
ANCESTRAL SIDE TRIPS
I will be making side trips from
LVIV
IVAN FRANKIVSK
CHERNIVTSI
TERNOPIL
KYIV
Click on down arrow for your selection
To
the Villages of
Please type YES or No
for your side trip(s):
I will need a car with driver
I
will need a car
I
will need a translator
or preferably
a driver/translator
Do
you have any questions or comments?
Bloor Travel Agency Limited
2336A Bloor St. West
Suite 200
Toronto ON
M6S 1P3
bloortravel@on.aibn.com
We are currently negotiating the costs for
the tour and will have the details very shortly. We will
post the particulars as soon as we get them. Part of the
process is knowing how many are interested in participating
in the tour. Knowing how many are interested will affect
the overall costs. A detailed itenerary will be posted
on this site. In the interim here is a tentative
itinerary.
I wish to reserve my space at this time.
NOTE:
When you click the "Okay, reserve a spot for me! " button,
it will bring up an e-mail message page with your data.
You must ALSO click the "Send" button on
the e-mail message page for the data to be sent out.
If
you have any difficulty using this form, please contact
us
You
may wish to retain a copy of this form. Print
this page by clicking the "Print This Form" button.
You can also print a blank copy of this form to do your
rough work on. Plus, you can snail mail it to:
Bloor Travel Agency
Limited
2336A Bloor St. West
Suite 200
Toronto ON
M6S 1P3
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