Cross Continental Travel, Let us take you on your next adventure!

Explore Wales
June 12-18, 2008

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 Single
Program fee of $2450 based on double occupancy/single supplement $70 per night.

Payment

Registration of $500 deposit due December 30, 2007 and Balance due: March 30, 2008.

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, (303) 480-8488 | cell (303) 519-9119 | fax (303) 327-8598 or email donna@crosscontinentaltravel.com.

Itinerary | Home
Phone (303) 988-5304 | cell (303) 519-9119
fax (303) 327-8598 | email donna@crosscontinentaltravel.com