ROAM Lifestyles 2023 Italy Registration

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Please complete a separate form for EACH person attending the ROAM Lifestyles 2023 Italy trip.

Email address: *

Participant's Last Name (as it appears on passport)
*

Participant's First and Middle Name (as it appears on passport)
*

Participant's Date of Birth *

YYYY

Participant's Gender *

Female

Male

Participant's Phone Number *

Participant's Mailing Address *

Do you have a current passport? *

Yes

If yes, what is you passport # and expiration date? (Must be valid 6 months after travel dates) *

Are you a student? *

Yes

Have you joined us on a ROAM Lifestyles trip before? *

Yes

Referral Name or Code *

Describe yourself in three words: *

T-Shirt size *

Adult XS

Adult S

Adult M

Adult L

Adult XL

Adult XXL

Other (please specify)

Does participant have any food allergies? *

Please give any information that will help us provide a meaningful and positive experience to meet your specific needs. (mental health needs, physical limitations, etc.)

What would you like to gain from this experience? *

Submit

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