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
