LIFE IMPACT TRAVEL APPLICATION FOR SEPT 2023

APPLICATION FOR TRAVEL

September 18-28th, 2023
Please return this application (PLEASE PRINT) along with a picture of your passport and $350.00 deposit to secure your space on this trip. If you would like a pdf version of this form, please email MHundy@gmail.com.
Full Name*
Street Address*
State*
ZIP code*
Date of Birth*

MonthDayYear
Date
E mail Address*
example@example.com
Telephone*
Format: (000) 000-0000.
Passport number*
Expiration Date*

MonthDayYear
Date
I have a passport from the country of*
Upload a picture of my passport or Email it to Mhundy@gmail.com

Cancelof
YesNo
Emergency Contact Name*
Emergency Contact Relationship *
Telephone number*
Format: (000) 000-0000.
YesNo
List Prescription Medications (Please note medical information will be kept private and not shared)*
List Allergies*
YesNo
Single Room with an additional charge of $995.00Double RoomTriple Room
Name of persons you would like to share a room with.
If you do not have a roommate, we will try our best to match you with someone. Please note that there is no guarantee that we will be able to match you with a roommate. We will offer you options at the time of booking the hotels.
My Polo Tshirt Size is*
When I receive your application and deposit, I will send you information on our itinerary, (including all the sites), the hotels we will be staying at flight information and other important information on how to prepare for your adventure. You can also fill out the application on the lifeimpacttravel.com website or at this link: https://docs.google.com/document/d/e/2PACX-1vQUN9zPBbQPsoGOkdUorEur-boGWYYepQCBasIuTj8GYNdFt6RRee4Jkj1ZODsCfA/pub. When I receive your deposit and application a packet of information will be sent to you.

For payment you can use CASHAPP ($Madhundy), ZELLE (using my email Iddress,mhundy@gmail.com), pay online at lifeimpacttravel.com or send a Check made out to LIFE IMPACT TRAVEL and mail to:

1660 RENAISSANCE COMMONS, #2301 BOYNTON BEACH, FL. 33426

If you have any concerns or questions, please call/text me at 786-236-3601 or e-mail at mhundy@gmail.com.
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APPLICATION FOR TRAVEL