assisi-eventinfo

Assisi Workshop
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Alan Cohen's Website

Pat Rodegast's Website


"The key to receiving what you desire is your willingness to accept it." — Alan Cohen


"Nothing can match or even come near the miracle of who you truly are." — Emmanuel through Pat Rodegast


The Basicilca of St. Francis, Assisi


A quiet street in Assisi


Statue of St. Francis of Assisi


A view from Assisi


A panoramic view of Florence


The Coloseum, Rome

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206 Tours Reservation Application

 

Please fully complete the following application in order to register for one of our many wonderful trips.   You may also complete this form and mail or fax (480-945-0691) it to our office. 

If you experience any difficulties submitting this form you may e-mail the form to us by completing the form and going to:  'file'  →  'send'  'page by e-mail' 

(e-mail to ariel@mishkaproductions.com). 

 

Reservation Made By

  

TOUR INFORMATION

Tour # (if applicable)    Mishka Productions
Destination    Assisi Workshop with Alan Cohen & Pat Rodegast
Departure Date    March 29 - April 05, 2006
Post Tour

   I will also join the 3 night Post Tour to FLORENCE $899

   I will also join the 3 night Post Tour to ROME $999

PASSENGER INFORMATION (Names MUST Be Exact Match to Your Passport)

Title

  

First Name

  

Middle Name

  

Last Name

  

I prefer to be called

  

Birthday (MM/DD/YY)

  

Address

  

Address 2

  

City, State, Zip Code

  

Country

  

Home Phone

  

Work/Cell Phone

  

Fax

  

E-Mail

  

Passport #

  

Exp.  

EMERGENCY CONTACT

Name   
Phone   

REGISTRATION OPTIONS

Land Only    I am registering for Land Only (arrival/departure transfers not included)
Departure City   
Accommodations   
Roommate Request   
Insurance    ($89 / $119 / $149 / $199 based on total trip costs)

SPECIAL REQUESTS

Seat Request   
Meal Request   
Wheelchair Request   
Other Needs   

:::  ADDITIONAL COMMENTS OR INFORMATION  :::

PAYMENT INFORMATION

A $500 per person deposit is due at the time of booking.

Payment in full is required at the time of booking if you are registering with in 60 days of departure. 

A $50 late booking fee is applied for bookings made with in 30 days of departure.



  I wish to make a direct credit card payment (only possible if more than 60 days prior to departure)
       Name on Credit Card 

 
       Type of Card        Visa       Master Card       American Express  
 
       Card Number    Exp. Date

 
         Charge the $500 per person deposit now
         Charge the $500 per person deposit & insurance now
         Charge total trip costs


  I wish to make my payment via Check or Money Order. I will send my payment by mail.

       If paying by check mail to:  Mishka Productions, PO Box 6547, Scottsdale, AZ 85261

 

 

Enrollment in and/or payment for any Mishka Productions/206 Tours trip or service

constitutes your unconditional acceptance of all applicable Terms & Conditions .

 

  Initial Here to agree to all Terms & Conditions

 

 

You may also print this form, complete it and fax it to us at 480-945-0691