Reservation Form for Vietnam: North to South
Trip Dates: December 2 – 15, 2018
Today's Date *
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Participant’s First Name *
As it appears on passport.
Your answer
Participant’s Nick Name
Do you prefer to go by another name?
Your answer
Middle Name
As it appears on passport.
Your answer
Last Name *
As it appears on passport.
Your answer
Complete Address *
This is the address to which you'd like any necessary travel documents sent.
Your answer
E-mail Address *
Your answer
Passport Number *
Your answer
Country of Issue *
Your answer
Passport Expiration Date *
Passport must not expire within 6 months of your return date in order to obtain necessary visa.
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Date of Birth *
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YYYY
Place of Birth - State *
State
Your answer
Place of Birth - Country *
Country
Your answer
Nationality *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact E-mail *
Your answer
Emergency Contact Phone *
Your answer
Single or Double Occupancy *
Choose one (if paying by direct deposit into our Bank of America account - see Payment Options below - please subtract $50)
Required
Name of Roommate
If applicable.
Your answer
Number of Beds *
Total Amount Remitted (including single supplement, if applicable) *
If submitting Other amount, please explain why. *
Your answer
How will you be remitting your funds? *
Please choose one.
How did you hear about us? *
i.e. Internet search, past tour participant, word-of-mouth, saw Ralph or other PEA leader speak, took a class with Ralph or other leader, other.
Your answer
Do you have a website you'd like to share?
If so, please give us the website address in the box below.
Your answer
DEADLINE TO REGISTER & PAY IN FULL FOR THIS PROGRAM IS AUGUST 2, 2018
IMPORTANT DETAILS

Please do not book any flights or other non-refundable travel arrangements until you receive a separate confirmation that we have the minimum number of participants required (6). At that time full payment will be due so that we can call the trip a go and everyone can have plenty of time to arrange their flights.

Only completed forms with deposit or full payment will be processed.

REQUIRED: Please send a copy of your passport signature page via e-mail to: admin@PhotoEnrichment.com. Can be a scan or high quality picture made with a smartphone.

PAYMENT OPTIONS
1. Credit cards can be accepted via PayPal with no additional fee. Please e-mail ralph@PhotoEnrichment.com to request an invoice (not available to non-U.S. residents. If located outside of the U.S. please use wire transfer or direct deposit options below).

2. Bank Transfer/Wire Transfer or direct deposit.

BANK OF AMERICA ACCOUNT INFO:

Bank Address: 3300 East Pacific Coast Highway
Corona del Mar, CA 92625

Company Name: PhotoEnrichment Programs, Inc.

Company Address: 4007 Landstrom Road
Rockford, IL 61114

Account #: 3250-2238-8032

Routing Number #: 026009593

COST:

Bank Transfer/Wire Transfer - Varies, there may be a small charge to you depending on your bank.

Direct deposit with personal check via counter credit at any Bank of America branch - FREE, and please enjoy a $50 discount if using this payment method.

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