REGISTRATION FORM
Name:_________________________________________________
Full Name on Passport:___________________________________
Passport Number: _______________________________________
Address:_______________________________________________
Phone Number:__________________________________________
Email Address:__________________________________________
Contact Person:_________________________________________
Choose A Tour:
Thailand:
a) Thai Medical Massage & Ancient Art Program
b) Thai Cuisine & Ancient Art Program
c) Gemological Sciences & Ancient Art Program
d) Thailand Ruins & Ancient Art Program
e) Theravada Buddhist Retreat & Ancient Art Program
f) Wedding on Elephants Package
g) Honeymoon Package
1) Quiet, Private, Package
2) The Deluxe Package
Cambodia
Vietnam
Food Preferences:
1) anything goes________________________________________
2) vegetarian___________________________________________
3) special: please specify_________________________________
Hotel occupancy: Double____________Single_______________
Flight Seat Preferences:_____________________________________
Birthdate:__________________Day of the Week:__________
Favorite Color:_____________________________________________
Swimming Capacity:_________________________________________
Special Needs:_____________________________________________
_________________________________________________________
Appointments you would like to have made for you while in Thailand:
a) Thai Medical Massage_________________
b) Optometrist:_________________________
c) Dentist:_____________________________
d) Eastern Astrology:____________________
e) Tarot:______________________________
f) Palmistry:___________________________
g) Acupuncture:________________________
Desires, expectations, things you would like to see or do,
or shop for on your journey...
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
Notes:
(cut & paste)