MWC Form | Atectravel

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Please take a moment to fill out the form. (THIS FORM IS FOR MODERN WIDOWS CLUB MEMERS ONLY)

What trip/tour do you want to book - Dates Of Travel

First Name as it appears on Passport

Middle Name as it appears on Passport

Last Name as it appears on Passport

Single Or double

Roomate Name (If applicable)

For cruises- Inside,Oceanview or Balcony

Name On Credit Card

Credit Card #

Expiration Date AND CVV #

Phone

Date Of Birth required

Street Address

Town/City

State/Province

Postal/zip code

Emergency Contact Name

Emergency Contact Phone Number

Disclaimers Required

Payments: I give permission for ATEC TRAVEL SYSTEMS, INC. to charge the credit card above for payments on this trip.

To the fullest extent permitted by law, I release and hold harmless ATEC TRAVEL SYSTEMS, INC, and Modern Widows Club, its owners, employees, and agents from any claims,damages,losses,injuries,delays, or expenses arising from my travel or from acts of third-party suppliers.

I understand the agency is not liable for events beyond its control, including but not limited to acts of God,war,civil unrest,pandemics,strikes, or govermental actions.

Photo Release: I give my permission to ATEC TRAVEL SYSTEMS, INC. and Modern Widows Club to use any picture that involves me for advertising purposes.

Thanks for submitting!

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