2008 ITU Duathlon World Championships, Rimini, IT
September 27-28, 2008
Travel Request Form
( Please print clearly )
Full name(s): (as shown on passport) _______________________________________________________
_____________________________________________________________________________________
Address: ______________________________________________________________________________________
City: _________________________Province: __________________Postal Code: ____________________
Tel: (Res)________________________________ (Bus/Cell) __________________________________
Email: ____________________________________________________________
Hotel Biancamano - Standard Hotel rooms
___ Single (one bed) ___ Double (one bed) ___ Triple (3 twin beds)
___ Double (2 beds) ___Triple (1 double bed and 1 twin bed)
Yes ____ please match me up with someone
I have made arrangements to share my room with______________________________________________
Full names (as shown on the passport) of others traveling with you who also require air reservations:
____________________________________________________________________________________
If you want us to book air flights for you please complete the following
Departure date: _________________________ Return date: ________________________________
Departure city: _________________________ Air Canada Aeroplan #: ________________________
Special airline meal request: e.g. Vegetarian, low cal, low salt, etc: _________________________________
Bikes: Please indicate how many people listed on this form will be taking a bike ________
What are the dimensions of the bike box? ____________________________________________________
For any hotel, air reservations, and insurance payments you must complete the following
*Credit card #- Visa or MC only : ________________________________________ Exp date: _____ / ______
Signature of authorization: ________________________________________________________________
(We will not charge your credit card until we confirm your booking and you give us the o.k.)
*If you are emailing your booking form to us, please do not put your credit card number on the form. We will call you for the number once we receive your form.
Insurance coverage: Yes ____ No ____
If yes, select one package: Deluxe Package ____ Non Medical Package _____
Note : This is very important. If you do not want coverage we require your signature below.
Signature: _________________________________________________ Date: ______________________
Date(s) of birth: (For insurance coverage) ___________________________________________________
Additional requests:
____________________________________________________________________________________
Contact: Shannon or Don
Heartland International Travel & Tours
202-3111 Portage Ave.
Winnipeg, Man. R3K 0W4
Toll free: 1-866-890-3377 Phone: 204-989-9630 Fax: 204-989-9636
Email bookings: shannonc@heartlandtravel.ca or donf@heartlandtravel.ca