Trip to Poland with Piast Institute 2020
May 18, 2020 - June 2, 2020

Please complete the information below. The full name as it appears in a passport is required.
Email address *
Legal Last name (as it appears in passport) *
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Legal First name (as it appears in passport) *
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Middle name
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Date of Birth *
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Email address *
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Phone number *
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Full address *
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Person's name you want to be in room with (please note that pricing is for a two person room). *
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Allergies /Food Restrictions
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Emergency Contact Information (Name, Contact Information)
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