Name (exactly as on passport) :______________________ Age ___

Name preferred to be used for badge ___________________

Home Address ______________________________________
_________________________

Zip Code, Place and state ____________________________

Telephone Number Home (______)__________ Work (_____)_______

School Name (if applicable) ____________________________

School address ______________________________________ 
______________________

In case of emergency contact __________________________

Address __________________________________________

Telephone Number (_____)__________Relationship______________

Emailaddress: ______________________

Remarks, general or concerning health, like diet : ____________
 

I would like someone to call me at   (______)_____________ 
Date and times preference: ____________
to answer my questions about the tour.


I have a spouse or friend who would
like to accompany on the trip (name as in passport):   ____________________
Badgename and age : ___________________

I would like to share a room (with)  ________________________

How did you hear about the tour? __________________________