ICMS Reservation Form
Washington DC / Gettysburg ICMS 8th grade trip May 16-19, 2006
Name of Parent / Guardian completing this form
First Name
Last Name
Name of Student Traveler
First Name
Last Name
Student Rooming List Info please select to indicate
Please Select
Male
Female
Name of any adult traveling NOTE: All adults and Chaperones must be approved by the school.
First Name
Last Name
Signature
Total Number of Travelers:
blank
Email Confirmation to
example@example.com
Billing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Parent / Guardian Signature -- Note: By signing this form and enrolling your student on this tour you are accepting that the school may cancel any student with NO REFUND at any time they deem there are, but not limited to, grade / behavioral / attendance issues
Please verify that you are human
*
Submit
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