REGISTRATION FOR ITALY 2011
Deposit with form below is due January 30, 2011.
Name ____________________________
Address __________________________
City, State, Zip ____________________
Phone __________________________
Email ___________________________
Emergency contact person_____________
Phone ____________________________
My roommate is ____________________.
____ I want a single room for $200 extra charge.
____ Enclosed is a $500 registration deposit.
____ Enclosed is a copy of my passport.
BALANCE ($4,000) IS DUE Monday, February 28. The pre-trip meeting is February 28, 7 pm at Tyler's condo, 1313 Lincoln, #201.
Please make checks payable to and send to:
Walk With Me
1430 Willamette St., #579
Eugene, OR 97401