REGISTRATION FORM

TOUR NAME:_____________________________________________

YOUR FULL NAME(S):_____________________________________

ADDRESS:________________________________________________

PHONE:__________________________________________________

E-MAIL:__________________________________________________

EMERGENCY CONTACT:__________________________________________________

            NAME:________________________________________________

            RELATIONSHIP:________________________________________

            PHONE#:______________________________________________

ACCOMMODATION:

            ---- DOUBLE OCCUPANCY.
                 
I plan to share a room with  _______________________________                          
           Bed Preference
                        ____ Double Bed         ____ Twin Beds 

            ---- I NEED A ROOM PARTNER. If a partner is not available the Single
                      Occupancy Supplement will be applicable.

            ---- SINGLE OCCUPANCY. The Single Occupancy Supplement is
                      applicable.

MEDICAL INFORMATION:

            Do you have any medical condition that might restrict your participation in the tour, or that the tour leader should be aware of for your safety, or in the event of an emergency? For example: mobility problems, diabetes, heart conditions, etc.

Please provide any relevant details on a separate sheet. 

Signature:__________________________    Date:_______________________