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DECLARATION To be completed by the First Passenger (Party Leader) on behalf of ALL of the party

MOBILITY DECLARATION

See “

Your Mobility & Tour Suitability

”, Booking Information, page A.

I declare that I and all of my party are capable of:

* Carrying and lifting our own luggage

on to and off trains?

YES

NO

* Walking at a reasonable pace as part

of a group?

YES

NO

* Climbing steps without assistance?

YES

NO

If the answer is

NO

to any of these questions, you or your

travel agent will need to discuss the suitability of your

chosen tour with Railtrail before booking.

Please do not hesitate to contact us.

Return this signed Booking Form by fax to

01538 382525

or post to:

Railtrail Tours Limited, 43 St. Edward Street, Leek, Staffordshire Moorlands ST13 5DN

Telephone: 01538 382323 email:

enquiry@railtrail.co.uk

web:

www.railtrail.co.uk

I have read and I understand the

Railtrail Booking Information

and I have provided the

Passenger Information

needed to process

this booking. I have read and I accept the

Railtrail Booking

Conditions

on behalf of all of the above named passengers and

understand the importance of the

Mobility Declaration

.

I enclose a deposit payment as described above, and undertake

on behalf of myself and my party to pay the required balance

money no later than

13 weeks

(Signature, European & Worldwide

tours) /

9 weeks

(UK tours) before the departure date.

Signed Date

Name (BLOCK CAPITALS)

Passenger 1 (Party Leader)

Passenger 2

Passenger Information

Please provide us with all the following information in order to fully process your booking.

Name

Special Diets

Any Medical Conditions

or Disabilities

Any Mobility

Restrictions

Next of Kin:

Name

Relationship

Home Telephone

Mobile

National Railcard:

Type

Number

Expiry Date

If a discount is claimed a valid National Railcard must be carried whilst on a UK tour.

Passport:

Number

& Issue Date

Expiry Date

Nationality

Country / Authority

issued by

A Passport is not required for UK tour bookings, but photo ID may need to be carried on some UK tours.

Are you travelling with anyone else on this tour who will have sent us a booking form independently?

If so, whom?

Please tick on both of your Booking Forms to indicate that you wish Railtrail to make adjacent seat reservations where possible.

Insurance Company

Insurer’s Emergency

Contact No.

Policy Number

Insurance is not mandatory for UK residents travelling on UK tours

2015

C