This form is for your convenience to print a reservation form for 2012 SEC Package.  NO information you fill in is transmitted over the Internet, the form must be mailed or faxed to Leader Travel.

Send To:      Leader Travel

                     410 Lake Street

                     Fulton, KY 42041

Attn:  Mike Homra

270-472-0008

800-776-3234

fax: 270-472-2112
 

Cardholder's Name: 

Cardholder's Signature:________________________________________

Account Number:  Exp. Date: /

Amount to be Charged:  $

   * remaining balance will be charged on January 2nd

Name:

Address:

City/State/Zip:

Email:

Phone: Day      Fax     

            Night      Cell     

Hotel:

 Roomate(s)

Additional Nights (specify date):
Special request (if available):  King   Double

                                                  Other

Check Here if you want to be contacted about lower level tickets. If so, how many?

I understand that this package is non-cancelable and non-refundable, unless covered under the terms

of the trip cancellation insurance.

             ______________________________________________________________

                                                           Signature