REGISTRATION FORM

REGISTRATION FORM
(please print clearly)
Date_______________________
Please complete a separate registration form for each tour. If you are registering multiple travelers with the same address,
you are only required to complete one form per tour. Contact us if you need additional forms. Use the back of this form if
additional space is needed. Mail the completed form(s) with payment to the address listed at the bottom.
Personal Information
Name(s):___________________________________________________________________________________________
Address:___________________________________________________________________________________________
City:________________________________________________ State:_________ Zip:______________________________
Home Phone:__________________________________________ Cell Phone:_____________________________________
Email Address:______________________________________________________________________________________
Special Needs:_______________________________________________________________________________________
(food allergies, use a walker or wheelchair, can’t walk long distances, need handicapped room, etc.)
Emergency Information
(list someone not traveling with you)
Emergency Contact Name:____________________________________________ Relationship:______________________
Emergency Contact Phone:_____________________________________________________________________________
Tour Information
Name of Tour:_______________________________________________________________________________________
Tour Date(s):_______________________________________________________ No. of Spaces Requested:____________
Name(s) for Name Tags:_______________________________________________________________________________
Traveling/Rooming With:______________________________________________________________________________
Hotel Room Preferences:  Single  Double  Triple  Quad
(for multi-day tours only)
Do you prefer a king bed?  Yes  No
 Smoking  Non-smoking
(many hotels are non-smoking only)
(not guaranteed)
Do you want to purchase Travel Insurance?  Yes  No
If yes, please provide the date of birth for each traveler:
Traveler #1:_________________________________________ Date of Birth:___________________________________
Traveler #2:_________________________________________ Date of Birth:___________________________________
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We will send you a quote for traveler’s insurance upon receiving your date of birth.
You must be medically able to travel on the day you purchase the insurance.
You must be without injury or illness 180 days immediately preceding and including your coverage effective date.
If insurance is purchased within 15 days of your first deposit, any pre-existing medical conditions are waived.
Capitol Tours takes photographs during our tours to share both internally and externally. Unless a traveler requests otherwise, Capitol Tours will
make the assumption that he/she gives us permission to photograph his/her image for use in any Capitol Tours’ publications or promotional materials
without any restrictions.
Capitol Tours accepts cash, checks (made payable to Capitol Tours), Visa, MasterCard and Discover. To pay by credit card, call 803.794.9661.
A division of Capitol Bus Lines, Inc.
2926 Leaphart Road • West Columbia, SC 29169
803.794.9661 • 800.777.9766 • 803.739.1450 (fax) • www.capitol-tours.com • [email protected]
CBL 04/14