The Atlanta Wine School's Italy Program "Under the Tuscan Vine"
October 9-15, 2005

Registration Form

Please list name as on your passport.

Where did you learn about this wine tour?

Name:

Passport Information
(Number, expiration and issue location.):

Guest Name:

Passport Information
(Number, expiration and issue location.):

Mailing Address:

City, State and Zip

Phone (include area code):

Email:

Special Remarks:

Emergency Contact Information:

Payment (indicate preference):

Personal Check              Credit Card *

Invoice (indicate preference):

Mail                               Email (PDF)

Airline

If you would like us to contact you regarding airline reservations check:

If you are making your own air arrangements please check here:

If paying by credit card, please fax information, card, number, expiration date, amount and signature
along with billing address to Att: June Spencer at Blaine Travel 404.591.7186.