Travel Registration Form Template

2027 Kilimanjaro Youth Soccer Safari and Summit

Registration Form
Name

PrefixFirst NameMiddle NameLast Name
Address
Soccer Club
Date of Birth
Month/Day/Year
E-mail
Phone Number
Expected Traveling Roommate (if any)
Please have your Spouse or Other Traveling Roommate Register Separately

Registration Deposit

2027 Kilimanjaro Soccer and Safari Summit Deposit$499.00

This payment is a non-refundable deposit for the 2027 Kilimanjaro Youth Soccer Safari and Summit. After receiving your deposit, you will be billed $2,500, which will be due on or before December 31, 2026.

Total $0.00

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty: