Spiritual Journey Application: October 21 - 27th   2012
Please print clearly as this is needed for your stay and in case of emergency. 

Full name (as it is on your passport)_______________________________________

Mailing Address________________________________________________________

City___________________________State_________________Zip_______________

Home Phone (       )_______________      Alt Phone (      )______________________

E-mail__________________________       Marital Status_______________________ 

Sex________Age________Height_______Weight ________Citizenship____________

Birthdate (month/day/year)__________________ Birthplace  ____________________

Occupation  ___________________________________________________________

Passport Number_________________________Place of Issue ___________________

Passport Expiration Date (must be 6 months after trip)__________________________

In case of Emergency contact: __________________________________________

Address_______________________________________________________________

Telephone_____________________________  Relationship______________________

 

Airline Flight Information:

Into Mexico City:      Date    ______________ Arrival Time _______________________

Airline and Flight number      _______________________________________________

Depart Mexico City: Date:    ____________ Departure Time ______________________

Airline and Flight Number      _______________________________________________

 

Final payment due by Sept 25th               Fee for Journey:                $1,195.00   

Double occupancy (Y or N)  (Single Room Supplement) $400.00):     __________________

                                                             Total Amount Due:      __________________        

$300.00 Deposit required for reservation        Deposit Amount          __________________

Roommate request __________________       Balance Due:            ___________________ 
(if known)