Reservation Form for Vietnam: North to South
Trip Dates: November 26 - December 9, 2017
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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Place of Birth - State
State
Your answer
Place of Birth - Country
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 (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 JULY 26, 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 (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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