West Coast Tour
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Fore More Information Contact:

David Berg
Petersburg Rotary
Viking Travel, Inc.
1-800-327-2571 or
907-772-3818
907-772-3940 fax

E-Mail: david@alaskaferry.com or see us on the web at www.alaskaferry.com/rotary

 

 

2012 - 24th Annual Rotary West Coast Tour
Online Registration Form

(Note: * Required Field)

Participant Information
*Complete First Name *Last Name as on Passport
*Name for your Name Badge
*American Address 1 American Address 2
*City *State
*Country *Zip
*Cell Phone *E-Mail Address
*Date of Birth DDMMMYY Male Female
"T" Shirt Size S M L XL    
Rotary Host Club & District - YEO or Counselor & District Officer Information
*Host Rotary Club
*District No.
*Rotary Counselor/YEO First Name

*Rotary Counselor/YEO Last Name

*Counselor Address 1
Counselor Address 2
*City
*State
*Country
*Zip
*Telephone
*Email
*District Chairman:
*Email
 

For use in case of emergency, please provide the names and addresses of your parents back home:

*Father
 
*Mother
 
*Address
*City
*State
*Zip
*Parent's Country
*Parent's Phone
*Parent's EMail

When completed, forward this application, together with your fee of US$1,550 in full, or the deposit of $499, completed Signed Rules form, two business cards and a copy of your Medical Form from the Long Form Application. Receipt will be acknowledged and a detailed itinerary and other information will be mailed to you. You will NOT be confirmed on the trip until all of these items are received.
Parents and students must sign the Rules Form. Send this link to your parents to print and sign, then send to you for your signature and submission: Rules Form

Ask your YEO for your Long Form and submit the Medical Permission form.. See a sample at Medical Release Form
DEPOSIT DUE UPON REGISTRATION and FULL PAYMENT IS DUE BY MARCH 15.

Make your check or money order for US$499 or US$1,599.00 to Viking Travel and mail to:

West Coast Tour
c/o Viking Travel, Inc.
Box 787
Petersburg, AK 99833

I will pay by Check Credit Card



 © Copyright Viking Travel, Inc. 2003-2012. All Rights Reserved. Updated 5 September 2011