Legacy Museum & Civil Rights Tour - June 25th - 28th, 2020
Registration & Deposit (Deposit is non-refundable)
Full Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Person, address & phone number
*
I acknowledge that at the hotel accommodations are double occupancy.
*
I will travel with a roommate
Please assign a roommate
I am traveling with a family of 4 or more
If you are traveling with your preferred roommate, type their full name in the box or enter NA.
*
I acknowledge the travel dates are June 25-28th, 2020. *
*
Yes
Select Your Payment Plan (Monthly Payments After Deposit)
*
10 Month/ $80
5 Month / 160
One Payment $900
Payment Options
*
Deposit $100.00 (Non-Refundable)
Total Payment $900
Add a child age 10 to 13 $225
Make Payment
*
prev
next
( X )
Legacy Museum Tour (FULL Payment)
$
900.00
Legacy Museum Tour Deposit
$
100.00
Total
$
0.00
Credit Card
Submit
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform