Student Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Passport Status *

Not Yet Applied For

Applied For

Have Passport

Passport Expiration Date

MM

DD

YYYY

Are you interested in joining the trip as a chaperone??

YES

NO

Parent #1 *

First Name

Last Name

Phone *

(###)

###

####

Parent #2

First Name

Last Name

Phone

(###)

###

####

Financial Commitments *

Deposit, Ticket Purchase, and Trip Balance invoices will be sent after registration is received. Fundraising support opportunities will be discussed with the confirmed families after registration.

I understand the total cost of the trip is up to $1,750

I agree to submit the $250 trip deposit by the September 29 deadline

I agree to submit the $500 airline ticket balance by the November 3 deadline

I agree to submit the $1000 trip balance by the January 19 deadline

I understand that the trip deposit and airline ticket are non-refundable after the deadlines