R
E S E R V A T I O N F O R M |
The Gardens of Dorset and Thames Valley with Jane Pepper
June 8 - 18, 2008
Please PRINT OUT and mail this completed
form, the completed waiver and release form and a $600 per person deposit (by credit card or check [payable to PHS]) to: Betsie
Blodgett, PHS, 100 N. 20th Street, Philadelphia, PA 19103-1495
| Full Name(s) |
| Preferred Salutation(s) |
| Street |
|
|
| Email |
| Roommate |
Accommodation (please check): ____ Double ____
Single |
| Amount Enclosed: $ |
Payment: ____ Check (payable to PHS)
____ Visa ____ MasterCard ____ American Express |
| Card # |
| Expiration Date |
| Name (as it appears on card) |
| I/we have read the Responsibility Clause and agree to all the conditions therein. |
|
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You must also submit a signed waiver and release form. |
