» Additional Information

Many countries require that your passport be valid for 6 months beyond   your expected return date. If your  passport expires sooner, please check with us.

We strongly recommend the purchase of travel insurance, please visit www.TravelInsured.com  using agent id #15849 to purchase reliable coverage.

Questions about enrollment? Call us at 800-451-7111 or email travel@holbrooktravel.com for assistance.

XLD Gisetc Costa Rica 2012 June 30, 2012 - July 08, 2012


» Contact information

First name*:  Last name*: 
Primary email*:  Secondary email:
Occupation:
Gender*: 
Date of birth (MM/DD/YYYY)*: 
Organization (Only If Using Organization Address): Address*:
Additional address: City*:
State*:

Zip code*:

International address: Home phone*:
Work phone: Cell phone:

» Travel information

Name as appears on passport:

Passport issuing country:

Passport #: Passport expiration date (MM/YYYY):
Membership information (if applicable): Please choose: roommate's name/assign roommate/single room
Medications: Dietary needs/restrictions:
Allergies: Other medical needs:
Emergency contact name:

Relationship:

Emergency contact home phone: Emergency contact alt phone:

» Air arrangements

We strongly recommend that Holbrook makes your air arrangements. We can assisist with securing discounted international airfare while providing you with complete service.
Would you like Holbrook to make air arrangements?* 
Air - departure city, state:
Seat preference:
Frequent flyer carrier number:

» Payment information

Type of credit card*:

Name as it appears on card*:

Credit card number: Security code:
Expiration date (MM/YYYY):

» Billing address

First name*: Last name*:
Address: Additional address:
City:

State:

Zip code: International address:

» Additional information

Additional comments (if applicable, add relevant membership information here):

» Terms and conditions/waiver