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Fall Colors trip to Boston and New England
October 12-14, 2012

Personal Data


Name
Mailing Address
City, State Zip
Home Telephone
Email

Male Female
Roomate's name
Roommate's Mailing Address
Roommate's City,State Zip
Roommate's Home Telephone
Roommate's Email

Male Female

 

Emergency Contact Person (Not travelling with you)



Your Contact Name
Relationship to you
Address
City, State, Zip
Home Telephone

Work Telephone
Roommate contact name
Relationship to roommate
Address
City, State, Zip
Home Telephone
Work Telephone

 

Travel Data

Accommodations: Twin Double Single
Program fee based on double occupancy
A Single will incur additional charges.

Payment

Participation fee: $875
Ground only: $700
Payment Deadline: August 30, 2012
Please make all checks payable to Cross-Continental Travel and mail to:
Donna Frazer-Palmer/Cross-Continental Travel
34 Wright Court
Lakewood, CO 80228

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

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

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Phone (303) 988-5304 | cell (303) 519-9119
fax (303) 825-1468 | email donna@crosscontinentaltravel.com