|   | 
            
            
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               * 	Name:                | 
                 | 
            
            
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                 * Base placement:                | 
                 | 
            
            
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                 *  Category numbers:                | 
                 | 
            
            
                | 
                 * Day of arrival - day of departure:                | 
                
		 -  
		  Format: DD.MM.YYYY (01.08.2003) | 
            
            
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                 *  Number of adults:                | 
                 | 
            
            
                | 
                 Number of children and their age                | 
                  Example: 2 children, 8 and 12 years | 
            
            
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                               | 
                
                  no 
                             yes | 
            
            
                | 
                 Backward tickets:                | 
                
                  no 
                             yes | 
            
            
                | 
                 Insurance:                | 
                
                  no 
                             yes | 
            
            
                | 
                 * Your city:                | 
                 | 
            
            
                | 
                 Contact phone:                 | 
                 country code 
               - | 
                city code 
               - | 
                telephone number 
               | 
        
            
                |   | 
                 if you do not know the country code or city, then leave the relevant fields blank  | 
        
            
                | 
                 Mobile phone:                | 
                country code 
                 - 
                 | 
                 operator code 
               - | 
                telephone number 
               | 
        
            
                | 
                 Your fax:                | 
                country code 
               - | 
                 city code 
                 -   | 
                 fax number 
                 | 
        
            
                | 
                 * Your e-mail:                | 
                 | 
            
            
                | 
                  Additional Information:                | 
                 | 
          
            
                |   | 
                 
               |