Application & Participation Agreement

Magic Code

School Name

Teacher / Leader

Full legal name is it appears on your passport:

Last Name First Name Middle Name

D.O.B. Age Male Female

Home Phone Cell Phone

Email Nationality

Passport # Expiration Date

Passport information can be forwarded to EA Tours at a later date as long as it is received BY YOUR FINAL PAYMENT DATE. TOUR SPACE IS LIMITED. If you do not yet have a passport, DO NOT DELAY submitting this application and initial payment.

Tour Information

Departure City Roommate Request

If available, I would like to pay a supplemental fee for: Double rm Single Rm

List all allergies

List any special medical/diet needs (Diet needs are not guaranteed)

Did you learn of this trip on Facebook? Yes No

Emergency Contact Information

Name

Address

City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip

Phone Cell Phone

Email

Person Responsible for Payment

Name

Address

City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip

Phone Cell Phone

Email

• The initial deposit, as stated on tour brochure, is non-refundable.
• Visa, Mastercard, Amex and other major credit can be used for ALL tour payments. Tour payments can be paid on more than one credit card.
• There is a discounted rate for paying with check or cash (please check on your tour's brochure).

I do NOT plan on using a credit card I DO plan on using a credit card

Terms of the Agreement

I agree to the terms and agreement Enter Applicant Name

Required if under 21 years of age Enter Parent/Guardian Name

Under the Electronic Signatures in Global and National Commerce Act (ESIGN), entering your name into the electronic signature field makes this electronic contract as legally binding as a paper-based contract.