56th Annual ICA Conference
RESERVATION FORM

Please complete this online form, click "SUBMIT" button on the bottom of this form, and mail this reservation form to GLOBAL TRAVEL BUREAU INC. to the address below :Application Date :

PERSON 1
First Name Middle Initial Last Name Date of Birth Nationality
Occupation Passport # Passport Date of Issue Passport Expiration Date
PERSON 2
First Name Middle Initial Last Name Date of Birth Nationality
Occupation Passport # Passport Date of Issue Passport Expiration Date
Address
City State ZIP
Home Phone ( ) Work Phone ( )
E-Mail Adress
Passports and Visas
All visitors are required to have a valid passport and for some countries.
Please Reserve Double Room Twin-share Single Room
Post Conference Tour
4 Days 3 Nights Prague Extension
Please book your return flight home from PRAGUE!

$450.00

Post Conference Tour
9 Days 8 Nights Prague/Budapest/Vienna Extension
Please book your return flight home from BUDAPEST!

$1819.00

Other additional services (Please Specify)

Reservation Conditions:

1. Completed booking form with deposit, must be received by GTB AS SOON AS POSSIBLE. A seperate confirmation will be issued directly upon receipt of payment.
2. Full payment must reach GTB before May 01, 2006.
3. A cancellation fee equal to 50% of the total cost will be levied for any cancellations received 30 days prior to tour departures. There will be no refunds for any cancellations received within 30 days of tour departure.
4. A handling fee of (USD)$20.00 will be charged for any reservation amendments.

Payment Terms:

By Certified U.S. Funds drawn upon a U.S. bank (i.e. Cashier's Check) payable to GTB-Global Travel Bureau, Inc.

By Credit Card  VISA  MasterCard  American Express
I, ___________________________________________________________, hereby authorized Global Travel Bureau, Inc. to charge my credit card for travel expenses in the amount indicated. The issuer of the card identified on this itemis authorized to pay the amount shown as total upon proper presentation. I agree to pay such total (together with any other charges due thereon) subject to and in accordance with the agreement governing the use of such card. I waive my right to dispute these charges. I have read the terms, conditions and cancellations policy of the tour and agree to same.

VISA ___________________ MASTERCARD ___________________________
AMERICAN EXPRESS _____________________________________________
Expiration Date ________________ Amount ______________________________
Expiration Date _____________________________________________________
Print Name as it appears on card:________________________________________
Credit Card Billing Address:____________________________________________
City:___________________________ State:________ ZIP:__________________
Daytime Telephone Number: ___________________________________________
Evening Telephone Number:____________________________________________

CARDHOLDER SIGNATURE:

X______________________________________________

Tour Number:_________________ Departure Date: ____________

I (we) fully and clearly understand that payment made for the confirmed booking is non-refundable in any circumstances and any cancellation is not acceptable as stated above.

Enclose is my DEPOSIT OF $ _________ ($250.00 per person) (BY CHECK OR MONEY ORDER) payable to: GLOBAL TRAVEL BUREAU INC.On receipt of the Reservation Form and your deposit we will make the necessary reservations and send you a confirmation and the invoice for the balance due.

FAX (or) MAIL TO : GLOBAL TRAVEL BUREAU INC
3703 Pontiac Drive
CARLSBAD, CA 92009
TEL 1 888 720 1628 FAX 818-363-4439
ATTN : JOSEPH CHAN