Booking Form

I. Personal Information:

A. Number of persons in party: _____ B. Please list their names, ages and occupations:

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C. Address __________________________________ City _____________________
     State ________   Zip ___________

D. Telephone _________________________ Fax _________________________

E. Please give us a description of yourself (ves), your interests and any special requirements to help us place you in the most appropriate host home:
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II. Accommodations required:

A. Number of bedrooms: Single [___] Twin [___] Double [___]

B. Private bath required: Yes [___] No [___]

C. English speaking family required: Yes [___] No [___]

D. Dates of nights to be reserved: from _______________ to ________________ inclusive.

E. Are you a smoker: Yes [___] No [___]

III. Arrival information:

A. Airline: _____________ B. Flight No.: ________ C. Date: ___________
D. Hour: ________     E. BHH airport pick-up required: Yes [___] No [___]

IV. Payment:

Enclosed is a bank Cashiers' Cheque in the amount of $ _____________ representing payment of the above requested accommodations. Please make cheque payable to the order of Vernon Bell.

V. Payment for these services manifests my agreement to the terms and conditions contained in the Booking Information.

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