:: Cuba Dance Holidays ::

Going to:

Where in Cuba:

Havana	Santiago de Cuba
Trinidad	Varadero

Departing From:

For how long?

When?

Who's going?

Type of Rooms

Type of Holiday

Type of Accommodation

E-Mail Address

Cuba Dance Holidays

BOOKING FORM

Cuba 2010

PERSONAL DETAILS

Full Name & Title

Address:		Postcode:

Telephone No:		Mobile:

Email Address:		Date of Birth:

Passport No:		Expiry Date:

Nationality:

VISA & INSURANCE

It is a condition of booking that you have your own adequate travel insurance arranged.

A valid visa is required for entry and exit when visiting Cuba. Please indicate if you would like the agent to arrange this for you.

yes No

ACCOMMODATION

Please indication your preference: Single Twin Triple

MEDICAL INFORMATION

Whilst you are responsible for your health for the period of travel is there any information that we should be made aware of in the event of an emergency?

Please provide the name, address and contact telephone number of the person we should contact in the event of an emergency

Name:

Telephone No:

Relationship:

Address:

ADDITIONAL INFORMATION

Is this your first trip to Cuba?

How would you describe your dance experience?

DECLARATION

I declare that I have read the enclosed terms and conditions and enclose a signed copy with this booking form. I agree to make payment to Habanaloko Limited the sum of £150 which is the non-refundable registration deposit. I accept to pay the balance of the total cost of the holiday 12 weeks prior to my holiday and failure to pay will result in the loss of both the £150.00 deposit and the reserved place.

I understand it is my responsibility to ensure my Passport is valid for at least six months after the time of my trip and that my Tourist Visa is valid.

I declare that I will arrange my own Travel Insurance adequate for travel to Cuba and I accept that Habanaloko Limited is not responsible for the loss, damage or theft of luggage, money or any personal effects and that any claim must be made through my own Insurance Company after reporting to the airline or Cuban authorities directly.

I accept that Habanaloko Limited do not accept responsibility in the unfortunate event of death, personal injury or failure of holiday arrangements and accept no liability for such either as a limited company or on behalf of its individuals.

I have read Terms and Conditions.

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