Email: wagonboss@historictrailswest.comYou may print this form out on your computer, fill out and mail it to
HISTORIC TRAILS WEST, PO Box 428, Mills, Wyoming 82644 Phone : 307-266-4868
| Name: | ||
| Address: | ||
| Phone: | Fax: | |
| City: | State: | Zip: |
| Country: | ||
| DATE OF EXPEDITION: | ||
| EXPEDITION NAME: | Meet at Town: | |
| Shuttle # of people: | X $45.00 = $ | |
| Arrival Time: __________ | At: __________ | |
| Departure Time: __________ | At:__________ | |
| Do all members of your party have health insurance? | Insurance Policy #: | |
| Purchse Trip Insurance: # X = $ | ||
| Names on Policy: | ||
| 1. | ||
| 2. | ||
| Adults Riding Wagons: (# of People)_______ X $________ = $________ | ||
| Names: | ||
| Ages: | ||
| Children (10 yrs and under) Riding Wagons: (# of People)________ X $________ = $________ | ||
| Names: | ||
| Ages: | ||
| Riding Horses: (# of People)_______ X $________ = $________ | ||
| Names: | ||
| Ages: | ||
| WE REQUIRE COMPLETED, WAIVER/RELEASE FORMS SIGNED BY EACH PERSON PRIOR TO EXPEDITION, UNDER 19 YEARS MUST ALSO BE SIGNED BY PARENT OR GUARDIAN.
CANCELLATION POLICY MAKE A COPY FOR YOUR RECORDS |
||
| Total Due: = $ ___________ (including Shuttle Fees if any) | ||
| 1/3 Deposit with Reservation: $ ___________ | ||
| Balance 30 Days Prior to Arrival: $ __________ | ||
| MC Visa # ____________________ | Exp Date (mm/yy): ____/_____ | |
| SIGNATURE OF PARTICIPANT | DATE:____/____/____ | |