Name:____________________________________________________________________________
Address:__________________________________________________________________________
City:______________________________________ State:____________ Zip:___________________
Phone:___________________________________________________________________________
Agency:__________________________________________________________________________
Contact Person:____________________________________________________________________
Address:__________________________________________________________________________
Email:____________________________________________________________________________
Day Phone:______________________________ Eve. Phone:_______________________________
Have you traveled with Sprout before? yes or no
TRIP PREFERENCES
List below the trips you would like to register for. Make sure that you have chosen a departure point that is offered for your trip. Spaces on trips fill up quickly. Please list alternate dates and/or trips.
Dates:_____________________________________ Cost:_________________
Departure point: (please circle one)
| -New York City- | -New Paltz, NY- | -Bridgeport/Hartford, CT- | -Carteret, NJ- |
Dates:_____________________________________ Cost:________________
Departure point: (please circle one)
| -New York City- | -New Paltz, NY- | -Bridgeport/Hartford, CT- | -Carteret, NJ- |
Trip deposit amount enclosed:________________________________________
Tax-deductible donation:____________________________________________
Total Enclosed:____________________________________________________
AGREEMENT:
I understand that trips are not confirmed until all documentation is submitted and approved by Sprout and a 50% deposit for each trip has been received. I have read and agree to the Terms & Regulations contained herein governing all trips sponsored by Sprout.
| Signature of Participant or Guardian | Date |