Registration Form – Peru 2010
Please print your name, address, home and cell phone, email address and emergency contact information.
Include with your deposit. Thank you.
City __________________________________Sate: ____________ ZIP ______________________
Home Tel. # __________________________ Work # _____________________________________
Cell # ________________________________ e-mail: ______________________________________
Website _______________________________Passport Country of issuance_____________________
Passport #______________________ Date of issuance _________ Date of Expiration_____________
Name on passport: _____________________________________ (Needed for arrangements in Peru)
Emergency contact: Name __________________________ Address _____________________________
City: _________________________ Sate: ______ Zip code: ________ Telephone # ________________
Email Address: _______________________________________________ for easy contact while traveling.
There will be a contact person in the U.S. who will send updates to your contact during our journey.
I am signing up for: Peru Journey April 14 - 24, 2010
Location: Cusco region, (Sacred Valley and Machu Picchu)
Contact Rev. Nancy at: email@example.com or call 714-739-5819 (leave message if we do not pick up).
Pre-Registration required. Make $500.00 deposit ASAP or by January 15, 2010,
or full payment $2,650.00 (double occupancy) to: Nancy Kimes. Single supplement add $390.00
(3% additional charge for credit card payment / paypal payment)
Amount enclosed $______________ Check#_____________ (Please do not mail cash).Mail to:
Full payment with $150.00 discount due by 10th of March, 60 days prior to departure for Lima, Peru.
Otherwise, full payment of $2,650.00 (double occupancy) due 30 days prior to departure for Lima, Peru.
I am ALSO interested in signing up for the 6-Day Extension Tour - Check here _____