Journey Application

Print Out & Complete This Application In BLOCK Letters.

Passport Must Have 6 Months Left On It Prior To Departure Date!

Name As It Appears On Your Passport:

Mr, Mrs, Miss, Ms:_____________________________________________________

Address:____________________________________________________________

___________________________________________________________________

Zip:________________________________________________________________

Home Phone:________________________________________________________

Cell:________________________________________________________________

E-mail:______________________________________________________________

Passport No:_________________________________________________________

Expiration Date:_______________________________________________________

Special Travel Requirements:_____________________________________________

Please Check Off Where Applicable:

_________ I wish to go on the 13 day / 12 night journey (US $1390 per adult - US $695 per child under 12 years of age)

I want Tony to arrange my flight ______________

I want to arrange my own flight _______________

Please note: if you arrange your own flight and the times do not coincide with the rest of the group, you 'may' have to pay extra costs for taxis and / or hotel.

Please Read, Fill In & Sign Below:

I wish to join Tony Garza's group to visit João de Deus at The Casa de Dom Inácio

Date of Journey:

From___________________________To___________________________

Please Check Off Where Applicable:

_________ I've made a deposit into Tony's Washington Mutual bank account / Paypal account or have mailed a postal money order / cashiers check of $500. I understand the remaining balance of $890 must be paid six weeks prior to departure date of which $500 is non-refundable unless Tony Garza cancels the journey.

_________ If less than six weeks from departure date, I've made the deposit for the full amount of $1390 into Tony's Washington Mutual bank account / Paypal account or have mailed a postal money order / cashiers check.

(After full payment has been made, then a refund is requested, $890 of the $1390 will be reimbursed within 60 days after a written request to do so has been received by Tony Garza. $500 is non-refundable unless Tony Garza cancels the journey).

Date of Deposit / Payment In Full

_________________________

I acknowledge and agree that any optional excursions, extra meals (taken outside the hotel), and taxis (except transfers to and from the airport) are not included in the price.

I acknowledge and agree that Tony Garza and his assistants are not responsible for carrier-caused delays anywhere, schedule changes, sickness or accidents nor any extra expenses, which may be incurred by these situations or by this journey.

CASA RULES FOR RECOVERY
If the simple rules given by the Casa staff, Tony Garza and / or his staff are not followed during the two-week stay by the participant named below, then all services may be cancelled at Mr. Garza's discretion and all monies paid for the journey forfeited.

I have read and understand the terms and conditions applicable to this booking.

Signature:__________________________________________________

Print Name:_________________________________________________

Date:______________________________________________________

After making the deposit / full payment, mail this Application & Indemnity Form (see next page) to:

Tony Garza
P.O. Box 15001
N. Hollywood, CA 91615-5001

A Receipt Will Be E-mailed To You.

Emergency Contact:

Name:_____________________________________________________

Relationship:________________________________________________

Home Phone:_______________________________________________

Cell:______________________________________________________

E-mail address:______________________________________________

How did you find out about this journey?

__________________________________________________________


				John of God Journey Application



	Escorted Journeys \| John of God \| Treatments \| Casa de Dom Inacio \| Testimonials \| Dates/Costs/Services \| Additional Services \| Journey Application \| Contact Tony


		Escorted Journeys To John of God In Brazil Print Out & Complete This Application In BLOCK Letters. Passport Must Have 6 Months Left On It Prior To Departure Date! Name As It Appears On Your Passport: Mr, Mrs, Miss, Ms:_____________________________________________________ Address:____________________________________________________________ ___________________________________________________________________ Zip:________________________________________________________________ Home Phone:________________________________________________________ Cell:________________________________________________________________ E-mail:______________________________________________________________ Passport No:_________________________________________________________ Expiration Date:_______________________________________________________ Special Travel Requirements:_____________________________________________ Please Check Off Where Applicable: _________ I wish to go on the 13 day / 12 night journey (US $1390 per adult - US $695 per child under 12 years of age) I want Tony to arrange my flight ______________ I want to arrange my own flight _______________ Please note: if you arrange your own flight and the times do not coincide with the rest of the group, you 'may' have to pay extra costs for taxis and / or hotel. Please Read, Fill In & Sign Below: I wish to join Tony Garza's group to visit João de Deus at The Casa de Dom Inácio Date of Journey: From___________________________To___________________________ Please Check Off Where Applicable: _________ I've made a deposit into Tony's Washington Mutual bank account / Paypal account or have mailed a postal money order / cashiers check of $500. I understand the remaining balance of $890 must be paid six weeks prior to departure date of which $500 is non-refundable unless Tony Garza cancels the journey. _________ If less than six weeks from departure date, I've made the deposit for the full amount of $1390 into Tony's Washington Mutual bank account / Paypal account or have mailed a postal money order / cashiers check. (After full payment has been made, then a refund is requested, $890 of the $1390 will be reimbursed within 60 days after a written request to do so has been received by Tony Garza. $500 is non-refundable unless Tony Garza cancels the journey). Date of Deposit / Payment In Full _________________________ I acknowledge and agree that any optional excursions, extra meals (taken outside the hotel), and taxis (except transfers to and from the airport) are not included in the price. I acknowledge and agree that Tony Garza and his assistants are not responsible for carrier-caused delays anywhere, schedule changes, sickness or accidents nor any extra expenses, which may be incurred by these situations or by this journey. CASA RULES FOR RECOVERY If the simple rules given by the Casa staff, Tony Garza and / or his staff are not followed during the two-week stay by the participant named below, then all services may be cancelled at Mr. Garza's discretion and all monies paid for the journey forfeited. I have read and understand the terms and conditions applicable to this booking. Signature:__________________________________________________ Print Name:_________________________________________________ Date:______________________________________________________ After making the deposit / full payment, mail this Application & Indemnity Form (see next page) to: Tony Garza P.O. Box 15001 N. Hollywood, CA 91615-5001 A Receipt Will Be E-mailed To You. Emergency Contact: Name:_____________________________________________________ Relationship:________________________________________________ Home Phone:_______________________________________________ Cell:______________________________________________________ E-mail address:______________________________________________ How did you find out about this journey? __________________________________________________________







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