Product Pre-Order Form

Best of Europe Grad Trip 2016 Application

July 6 - 26, 2016
Upload Photo of Yourself

Upload a File

Cancelof
Applicants Full Name (As it appears in your passport)*

First NameMiddle NameLast Name
Parent of Legal Guardian (If applicant is under 18 years old at time of registration)

First NameMiddle NameLast Name
Month of Birth*
Day of Birth*
Year of Birth*
Gender*

MaleFemale
Cell Phone*
Ex. (310) 501-7365
Home Phone*
Ex. (310) 501-7365
Email Address*
Passport #*
Country of Citizenship*
Address (No PO Box)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
It is strongly suggested that you purchase trip insurance. We can purchase your trip insurance for you. We can calculate the cost of your insurance for you if you choose to have G.E.T. purchase it for you.*

Yes, please purchase insurance for me at an additional cost to my travel package price.No, I do not want to purchase insurance at this time or will purchase on my own.Will decide at a later time.
Emergency Contacts
Emergency Contact #1*

First NameLast Name
Relationship
Contact #1: Day Phone Number*
Ex. (310) 501-7365
Contact #1: Evening Phone Number*
Ex. (310) 501-7365
Contact #1 Email Address*
Emergency Contact #2*

First NameLast Name
Relationship
Contact #2: Day Phone Number*
Ex. (310) 501-7365
Contact #2: Evening Contact Number*
Ex. (310) 501-7365
Contact #2 Email Address*
Emergency Medical Information
Allergies (List all food, medicine, other)*
Medication(s) Needed: List all medications (over-the-counter & prescription)*
List Important Past Medical History*
Swimming Ability*

Can not swimBeginning swimmerMaster swimmer
Medical Release Clause:

I AGREE THAT THE TOUR GUIDES FROM GREAT EXPECTATIONS TRAVELS MAY GIVE MY PERMISSION TO HAVE MEDICAL OR SURGICAL ASSISTANCE PERFORMED IF REQUIRED AND THAT I WILL BE RESPONSIBLE FOR PAYMENT OF EXPENSES INCURRED. (Medical and trip insurance is NOT included in the trip price) IT IS UNDERSTOOD THAT THIS CONSENT IS GIVEN IN ADVANCE OF ANY ACCIDENT OR INJURY OR ILLNESS THAT REQUIRES DIAGNOSIS AND / OR TREATMENT, BUT IS GIVEN TO ENCOURAGE THE DOCTORS TO USE THEIR BEST MEDICAL JUDGEMENT AND PROCEED IMMEDIATELY WITH ANY NECESSARY TREATMENT. THIS AUTHORIZATION FOR DIAGNOSIS AND/OR TREATMENT SHALL REMAIN EFFECTIVE FOR THE DURATION OF THIS TOUR. IT IS ALSO UNDERSTOOD THAT THE TOUR LEADERS WILL TRY TO CONTACT ONE OF MY EMERGENCY CONTACTS PRIOR TO TREATMENT BUT IF NONE CAN BE REACHED, THE ABOVE CONSENT WILL BE EFFECTIVE.
Payment
Payment Type *

CheckCredit CardPaypal
If paying by check, please add the name of student applicant on the Memo line. Send checks for deposit or full payment to:

Great Expectations Travels

Attn: Best of Europe 2016

5364 Venice Blvd., Suite #201

Los Angeles, CA 90019

Payment Options*

Best of Europe Grad Trip 2016$3,499.00

Limited Spaces Only$3,299.00

Trip Deposit$300.00

Subtotal $0.00Tax $0.00Total $0.00

Payment Method
Credit	Express
Credit	What is PayPal?

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Click to edit

Option 1Option 2Option 3
Click to edit
Click to edit

Option 1Option 2Option 3
Should be Empty:

Best of Europe Grad Trip 2016 Application

Emergency Contacts

Emergency Medical Information

Medical Release Clause:

Payment