Application

Please complete this form.

Trip Destination ________________________________________________

Participant’s full name____________________________Sex_________Age_____

(Please list your name as it will appear on your flight ticket, passport, ID)

Address_________________________________________________________

Home phone__________________Mobile_________________Email__________

Address__________________________________________________________

In case of emergency, please notify_______________________________________

Relationship_________________________________________

Day phone_____________________Evening phone________________________

Please submit this application with a $300 deposit made payable to Debbie Jacobs. 

The balance is required 90 days prior to departure.

 Debbie Jacobs

2458 River Road, Guilford VT 05301

phone: 802-257-0152    email: exploretravel@gmail.com