Full name *
Card No. *
Address *
City *
State *	Select State Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh chattisgarh Delhi & NCR Goa Gujarat Haryana Himachal Pradesh Jammu and Kashmir Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Pondichery Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttaranchal West Bengal
Pincode *
Tel.(Landline):
Mobile No. *
Email *

TRAVEL PREFERENCES(Please mention three different destination & three travel dates)
Preferred Destination(s):
1st Preferred Destination (L1): *
2nd Preferred Destination (L2): *
3rd Preferred Destination (L3): *
Preferred Date(s):
1st (D1): *
2nd (D2): *
3rd (D3): *
Payment Details:(Toward booking)
Demand Draft/Cheque No. *
Demand Draft/Cheque Date *
Bank *
Terms & Conditions for registration I have read & understood the terms and conditions of the offer as mentioned overieaf and agree to abide by the same. I further acknowledge that Davisclub shall nbot be responsible for any loss, damage or disappointment suffered by me due to over booking errors, oversights, or service issues at participating hotels or for any other reason beyond their reasonable control.