Extension Successful Gardener -
Featuring Great Gardens and Attractions of the Mid-Atlantic United States

Please return this form to:

Jean Wells Travel
Attn: Jean Wells
2300 Westover Drive
Winston-Salem, North Carolina 27103

Name(s) of travelers sharing a room:
Name 1: ___________________________

Name 2: ___________________________

Address:__________________________________________________

City: _______________________ State:___________Zip:________
(Please add additional addresses in upper left corner.)

Tel.Home:_____________________Office:______________________

Email Address: ____________________________________________

Form of payment: Check preferred______Visa______Mastercard___

Deposit per person: $400
Card Number:______________________________________________

Expiration Date: _____________

Signature: ______________________

Please indicate room: Double: _____ Single: _____
(All rooms will be non-smoking unless indicated otherwise - please attach a note.)

**Final documents will be available to you 2-3 weeks prior to departure.
**A Travel Guard insurance brochure will be sent upon receipt of your deposit.
**Please make a copy of this application.

**Please tell us of any any special celebrations during this trip??

______________________________________________________

**Any special concerns or needs?? _________________________

_______________________________________________________

Terms and Conditions
Payments:
Tour price is based on 30 participants
*Deposit in the amount of $400 per person required to secure reservation
*Deposits are being accepted at this time until all spaces have been filled
*Final payment in full required by Tuesday, May 1, 2007

Cancellation Penalties
**Before April 6, 2007, $55 per person
**April 9, 2007, Deposit Non-Refundable
**April 13, 2007 No Refund
**Trip cancellation insurance is available and recommended. Upon receipt of your deposit, a Travel Guard trip cancellation brochure will be sent to you.