CONTACT INFORMATION

Your name exactly as it appears on your passport:
Mailing Address:

Telephone:
Email:

PASSPORT INFORMATION

Passport #: Please call 508-240-7090 with this #.
Date of issue:
Date of expiration:
Date of Birth:
Place of Birth:
Gender: MaleFemale

ACCOMMODATIONS

Price is based on double occupancy
I will share a room:
YesNo

I will share a room with:

Number of beds in room:
2 beds1 bed1 or 2 beds OK

Please arrange for a same-gender room-mate:
YesNo

I prefer a single room*
YesNo
*If you wish to have a single room for the entire trip, there is a supplementary fee of $400.

FOOD ALLERGIES

YesNo
If yes, please specify any:

To pay by credit card please indicate when you send your registration form in and call us at 508-240-7090.