Cross Continental Travel, Your Educational Travel and Travel For Credit Specialist!

Alaska Cruise - July 9-16, 2012

Denali Land Tour - July 16-20, 2012

Personal Data

Legal Name
(as it appears on your passport)

Mailing Address

City, State Zip

Home Telephone

Are you a US citizen?
Yes No

Date of Birth
(MMDDYY)

Male Female

Passport #

Country of Issue

Spouse or roomate's name
(as it appears on their passport)

Roommate's Mailing Address

Roommate's City,State Zip

Roommate's Home Telephone

Roommate's Email

Is your Roommate a US citizen?
Yes No

Roommate's Date of Birth (MMDDYY)

Male Female

Roommate's Passport #

Country of Issue

Emergency Contact Person (Not travelling with you)

Your Contact Name

Relationship to you

Address

City, State, Zip

Home Telephone

Work Telephone

Room mate contact name (If different from yours)

Relationship to roommate

Address

City, State, Zip

Home Telephone

Work Telephone

Travel Data

Accommodations: Twin Double
Program fee based on double occupancy.

Cruise Trip Cost: $2150

Cruise/Denali Tour Cost: $2950
Total

Payment

Make all checks payable to Cross-Continental Travel and mail to:
Donna Frazer-Palmer/Cross-Continental Travel
34 Wright Court
Lakewood, CO 80228

Timetable

$500 deposit by March 30, 2012.
Balance of $1400 due May 15, 2012.
Denali Extension $800 due May 30, 2012.

OR

Payment via Mastercard/Visa or PayPal (a 3% fee will be added).

Release and Agreement

Don't forget to "sign" and submit your application.
By submitting this application you agree that you have read and fully understand the "Release and Agreement" and the "Booking Conditions" as supplied herewith, and agree to be bound hereby, and to comply therewith.

Signature Date

Itinerary | Home
For information call (303) 988-5304 or | cell (303) 519-9119
fax (303) 825-1468 | email donna@crosscontinentaltravel.com