Artemisia Registration Form

If you would prefer to print and post your registration form, you can download it here.

We are delighted that you wish to join one of our trips. Please read the following very carefully before proceeding: This registration form is legally binding between AHA Courses Ltd and the person responsible for paying the fees and must be filled out by the feepayer. Once you have submitted this form, you will be sent the means of payment for the deposit. In order for your place to be totally secure, we must receive payment of the deposit within 7 working days of the date of submission.

* indicates obligatory field

Trip Name *

Dates of Trip *

Client Details, Client 1

First name (as it appears on passport) *

Preferred name (if different from above)

Last name (as it appears on passport) *

Date of Birth (Please enter as DD/MM/YY) *

Passport Number *

Passport Issue Date *

Passport Expiry Date *

Place of Issue *

Nationality *

Do you need a visa? *

Yes

Mobile Telephone Number *

Email *

Client Details, Client 2

First name (as it appears on passport)

Preferred name (if different from above)

Last name (as it appears on passport)

Date of Birth (Please enter as DD/MM/YY)

Passport Number

Passport Issue Date

Passport Expiry Date

Place of Issue

Nationality

Do you need a visa?

Yes

Mobile Telephone Number

When travelling with AHA Courses Ltd, you must have travel insurance which covers expenses and repatriation. Insurance taken out at the time of booking will give protection for the deposit paid.

Name of Insurers *

Policy Number *

Their Emergency Services contact number *

Client 1, Medical Condition *

Client 2, Medical Condition

Client 1, Medication *

Client 2, Medication

Client 1, Dietary Requirements *

Client 2, Dietary Requirements

Address (Line 1) *

Address (Line 2) *

Town *

County & Country *

Postcode *

Home Telephone Number *

Emergency contact name and telephone number for family member or friend in the UK: (optional)

Today's date *

Would you like a double room for single use? (please note single occupancy supplement)

Yes

TRAVEL INSURANCE: I understand that by submitting this form I undertake to organise comprehensive travel insurance for the duration of the trip and I will ensure the policy covers all repatriation and medical expenses. PASSPORTS & VISAS: I understand that by submitting this form I undertake to ensure I have a valid passport for travel over the dates shown above and will organise any necessary visas for travel to Italy. YOUR DETAILS: I understand that AHA Courses will securely hold my details on their database, will not pass them onto any third parties and will use them exclusively in connection with all AHA courses and events. THE DEPOSIT: I will send a deposit of £600 within 7 days of submission of this form. (On receipt of this form we will email you details of how to make a deposit payment. Payments to be made by bank transfer or cheque; please note that we cannot accept credit card payments. Your place will only be secured on receipt of the deposit payment). I have read the Terms and Conditions taking special notice of the cancellation procedure.

I have read the Terms & Conditions taking special notice of the cancellation procedure.

You will get a "thank you" page once this form is successfully submitted and then a welcome email. If you do not receive these, the application has not been processed, so please email us, charlie@arthistoryabroad.com, so we know you want to join us.

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