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

Take a Bite of the Big Apple
A comprehensive tour of New York City
June 15 — 17, 2012

Personal Data

Name

Mailing Address

City, State Zip

Home Telephone

Male Female

Spouse or 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

Room mate contact name (If different from yours)

Relationship to roommate

Address

City, State, Zip

Home Telephone

Work Telephone

Travel Data

Accommodations: Twin Double Single
$1000 Program fee based on double occupancy.
A single is an additional $240.

Payment

Registration and $250 deposit due January 31, 2012.
Balance due; March 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

Timetable: Call for payment timetable.

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, (303) 982-7127 | cell (303) 519-9119 | fax (303) 825-1468 or email donna@crosscontinentaltravel.com.

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