Customized travel for individuals with disabilities

All About Us Background and Experience Disability Travel Services Unique Opportunities Expecially in ... Accessible Weddings Disability Sports Accessible Vacation Rental Accessible Resources Site map	Individual Travelers Reservation Form Tour Operators and Travel Agents PLEASE CLICK HERE Email (Mandatory) Full Name (Mandatory) Name of Company Nationality Street/PO Box (Mandatory) City and State (Mandatory) Home Tel. number (Mandatory) Work number Fax number Web Site address To receive one of our standard group tours Please check here To reserve our individual travel services Check here and fill in the below information Total Number of Persons Traveling (including infants and children) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Number of Persons with Disabilities Traveling 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Indicate type of disability: physical visual audio other Please indicate if you use: manual wheelchair electric wheelchair scooter crutches Dates Arrival Date January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Departure Date January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Cities Cities you wish to visit Florence Rome Venice Milan Siena Pisa Other Other How Many Days Florence Rome Venice Milan Siena Pisa Other Other Hotels No. of nights (Total no. of nights you want to stay in Italy) Type of accommodations Budget - Moderate - Luxury No. of rooms (Total no. of rooms you need in Italy) How Many Rooms No. of single rooms needed No. of double rooms needed No. of triple rooms needed Room Characteristics Roll-in shower 0 1 2 3 4 5 6 7 8 9 10 - Accessible Bath 0 1 2 3 4 5 6 7 8 9 10 - Able-bodied 0 1 2 3 4 5 6 7 8 9 10 Hotel Special Request Transportation Transfer None Minivan Coach Train No. of seats (Total no. of seats) Seat Characteristics Tie-down 0 1 2 3 4 5 6 7 8 9 10 - Accessible 0 1 2 3 4 5 6 7 8 9 10 - Able-bodied 0 1 2 3 4 5 6 7 8 9 10 Location from to from to from to Transportation Special Request Museums Name of Museums No. of tickets (Total no. of Tickets) Rental Equipment Rental Equipment None Manual Wheelchair Electric Wheelchair Scooter Portable Ramp No. of Days Rental Special Request Assistant / Guide Assistant / Guide None Accompanying Assistant Tour guide Nurse Cities Other Other Special Requests General Comments
ACCESSIBLE ITALY     Via C. Manetti 34 47891 Dogana Repubblica di San Marino E-mail: info@accessibleitaly.com Tel. from Europe: +378-941111 or +378- 0549- 941111 from US: 011-378- 0549- 941111 or 011-378- 941111 Fax from Europe: +378-941110 or +378- 0549- 941110 from US: 011-378- 0549- 941110 or 011-378- 941110