Application Form
Name:______________________________________________________________________
Last Middle First
Phone:
Home Address:______________________________________________________________
Number Street City State Zip
Business:_______________________________________Phone:____________
Address:____________________________________________________________________
Number Street City State Zip
Position:___________________________________________________________________
Health Concerns: What is your major health concern(s) if any, that you would
want to consult with Chinese doctors about? (This will help identify the doctor
you will meet.)
_________________________________________________________________________
___________________________________________________________________________
____________________________________
General Health: Please document in the lines below any health related
conditions that may limit your ability to function in a foreign country.
Use the back of this sheet if necessary.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
_______________________________________________________________
Please provide the name and address of your health insurance carrier and
your group number or individual identification number.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________
Please send your application with a non-refundable application fee for
$50.00 in a check or money order made payable to: Natural Health Tours, Inc.
at the address stated above.
Tour Cost (Valid through October, 2000)
1-2 persons: $2500USD + air fare
3-5 persons: $2300USD + air fare
6-9 persons: $2100USD + air fare
10 and above: $1900USD + air fare
Package includes China visa, rooms (double occupancy) at three star tourist
hotels, meals, transport, tickets, entry fees and two visits to a Chinese
doctor. Single supplements are available for an additional $400USD. Every
effort will be made to get the lowest airfare possible and to get more
people sign up in order to organize larger groups to reduce cost.
Please circle your choice of dates for travel.
July, 2000/ August, 2000/ September, 2000/ October, 2000/ Other (specify)
