Print RESERVATION FORM  Please carefully read and complete this form, sign, and fax to: (844) 776 4447 or mail to: Viet Vision Travel JSC,  2nd Floor, No 6 Vu Ngoc Phan st, Dong Da , Hanoi, Vietnam, or email to info@vnviews.com

CONTACT INFORMATION Name:......................................................................................................................................... Mailing address:........................................................................................................................... Phone (business):..................................Phone (home):................................................................. Fax:..................................................... Email:............................................................................. Name of Emergency Contact:........................................................................................................ Relation............................................................ Phone:................................................................

TRIP PARTICIPANTS' INFORMATION (also used for Visa Processing where applicable) Insurance: All tour participants are required to have health and/or travel insurance to participate on the trip.  Participant #1: Name (as it appears on passport):     ................................................................. Citizenship:...................................................... Occupation:.......................................................... Passport No:..................................................... Date of Birth:....................................................... Issue Date:...................................................... Expiration Date:.................................................... Special Requirements (eg. vegetarian, diabetic, allergies, medical conditions etc.) : ..................................................................................................................................................  Accommodation: o I will share a double room      o I prefer single accommodation at supplemental cost Name of insurance policy:................................. Insurance No.:...................................................... Expiration:................................................................................................................................... Participant #2: Name (as it appears on passport): ...................................................................... Citizenship:.........................................................Occupation:........................................................ Passport No:......................................................Date of Birth:....................................................... Issue Date:...................................................... Expiration Date:.................................................... Special Requirements (eg. vegetarian, diabetic, allergies, medical conditions etc.) : .................................................................................................................................................  Accommodation: o I will share a double room      o I prefer single accommodation at supplemental cost Name of insurance policy:.................................. Insurance No.:..................................................... Expiration:................................................................................................................................... Participant #3: Name (as it appears on passport):    .................................................................... Citizenship:....................................................... Occupation:......................................................... Passport No:..................................................... Date of Birth:....................................................... Issue Date:....................................................... Expiration Date:................................................... Special Requirements (eg. vegetarian, diabetic, allergies, medical conditions etc.) : ..................................................................................................................................................  Accommodation: o I will share a double room      o I prefer single accommodation at supplemental cost Name of insurance policy:................................. Insurance No.:...................................................... Expiration:...................................................................................................................................

Participant #4: Name (as it appears on passport):  ..................................................................... Citizenship:.....................................................Occupation:............................................................ Passport No:.................................................... Date of Birth:........................................................ Issue Date:...................................................... Expiration Date:..................................................... Special Requirements (eg. vegetarian, diabetic, allergies, medical conditions etc.) : ..................................................................................................................................................  Accommodation: o I will share a double room      o I prefer single accommodation at supplemental cost Name of insurance policy:..................................Insurance No.:...................................................... Expiration:...................................................................................................................................  PAYMENT INFORMATION  I am paying a NON REFUNDABLE deposit of  $......................................to Viet Vision Travel by:  o Bank transfer     o cash          o credit card (Charge to: oVisa   oMasterCard - SBJ code: ...... ) Name as stated on credit card:..................................................................................................... Credit Card No:................................................ Expiration Date:.................................................... SJC code: .................................................................................................................................. I authorize Viet Vision Travel to debit the total amount of:............................................................... Signature:......................................................... Date:.................................................................  I have read, understood, and accept the Terms and Conditions  and release and discharge Viet Vision Travel and its representatives from and against any liability arising from participation on the tour. Signature:.......................................................Date:.................................................................