Reservation Form
(please print out this form and return to us)

ENCLOSED IS OUR TOTAL DEPOSIT OF $_____________ ($_______ PER PERSON) FOR _______ PERSONS.
__ Payment enclosed by check or money order
__ Please charge the following credit card in the amount of _______________
Card Name: VI MC AX Card Number: ___________________________________ Exp. Date _______
Name of Card Holder (as it appears on card: ______________________________________________________
Cardholder billing address (if different than below) _________________________________________________________________________________________

PLEASE RESERVE THE FOLLOWING:
TOUR NAME: ___________________________________________ DATE (s): _____________________

DEPARTURE POINT: East Shore – Harrisburg Mall Pole 32 West Shore | KMART on Carlisle Pike Mechbg. (circle one please)

NAMES OF PASSENGERS AND AGES: _________________________________________________________________________________________

_________________________________________________________________________________________

ADDRESS _______________________________________________

CITY:_________________________________

STATE:______ ZIP: ____________

PHONE (DAY) (_ _)__________ (EVE) (_____)_________________

EMAIL: __________________________________________________

WOMANCARE MEMBER # (if any): ________________________________

Please return this form to us at:

GirlfriendTravel
1061 S Cameron Street
Harrisburg, PA 17104

FAX this form to us at: (717) 233-7716
Attention: Wendy Knaub

Departure locations for boarding the coach:

WEST SHORE: Kmart Shopping Center Lot (far left by Rohrer Sign) 5600 Carlisle Pike, Mechanicsburg

EAST SHORE: Harrisburg Mall Annex (near Toys R Us and The Bus Stop), Pole 32; 3354 Paxton Street, Harrisburg

If you have any questions, please call us at (800) 735-2400 or (717) 230-8000 X 30.