Reservation Form for 2017 Cambodia: Kingdom of Wonder
Trip Dates: November 6 - 19, 2017
Today's Date
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Participant’s First Name
As it appears on passport.
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 any necessary visas.
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Date of Birth
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Place of Birth
State
Your answer
Place of Birth
Country
Your answer
Nationality
Your answer
Occupation
Please put "Retired" or "Unemployed" if this is the case.
Your answer
Emergency Contact Name
Your answer
Emergency Contact E-mail
Your answer
Emergency Contact Phone
Your answer
Single or Double Occupancy
Choose one. Please subtract $50 if you decide to pay using a method other than PayPal (see Payment Options below).
Required
Explanation if paying "Other" amount above.
Your answer
Name of Roommate
If applicable.
Your answer
Number of Beds
Total Amount Remitted (including single supplement, if applicable)
A minimum deposit of $750 is required to reserve your spot on this trip. Full payment will be due by July 31, 2017, at the latest.
Your answer
How will you be remitting your funds?
Please choose one
Please list any dietary restrictions you may have.
We'll do our best to accommodate your request.
Your answer
DEADLINE TO REGISTER AND PAY IN FULL FOR THIS PROGRAM IS JULY 31, 2017
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 (4). 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.

PAYMENT OPTIONS:

1. Credit cards can be accepted via PayPal with no additional fee. Please e-mail ralph@PhotoEnrichment.com to request an invoice.

2. Bank Transfer/Wire Transfer, or direct deposit via counter credit at any Bank of America branch.

Bank of America Account Info:

Company Name: PhotoEnrichment Programs, Inc.

Account #: 325022388032

Routing Number #: 026009593

Company Zip Code: 61114

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

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