The entire form must be completed (IN BLACK INK) and returned to secure  your selected departure date.             FR43b 2005

Name_________________________________________ D.O.B.____________ Today's date____________

Companion's name____________________________________ D.O.B.____________ #in party_____

Address___________________________________ City__________________ State________ Zip_______

Phone (D)______________________ (E)____________________ FAX_______________________

Destination desired:            ___ Orlando         ___ Daytona Beach    E mail ____________________________

Method of travel to Florida     (  ) Flying                (  ) Driving

This offer provides three nights of accommodations at the Radisson Barcelo Hotel or the Clarion Maingate Hotel. Please allow at least 30 days advance notice from date that we receive  your reservation request. Reservations with less than 30 days advance notice will incur a $25 short notice processing fee. Please read Privileges and Provisions before setting travel dates. Please give two dates (with at least 7 days between dates); we will attempt to fill your first date based upon availability:

1st date requested__________________                          2nd date requested__________________

Please include the balance due of $ 199.00 (U.S. Funds) per couple* payable to A.S.I. with your reservation request; these funds will be applied to your reservation within 72 hours of confirmation. If you need assistance, please call our customer service department (M-F, 10:00 a.m. - 6:00 p.m.) at (386)523-0036.

* There will be a $20 per night surcharge for travel from 12-23-04 to 01-01-05, and from 03-25-05 to 04-02-05.

I/We have read and agree to all terms & conditions of this offer.

X______________________________________________

Mail or fax to:                          

A.S.I. TRAVEL DIRECT                                                              FILE # :     ______________

3 Sunshine Blvd.                

Ormond Beach, FL. 32174                                                        SERIAL #   : FR43b FAX

FAX (386)673-6005

                                                                                                  EXPIRATION :  12-20-05

If you wish to pay your balance via credit card, please fill out the following:

Name on card: _________________________________ expiration: _____________

card type and number: _________________________________________________

Signature: _____________________________________________________