Rotary District 5010, Youth Exchange West Coast Tour



	West Coast Tour Homepage


	AlaskaFerry.com Homepage

	Send This Page to a Friend!!!

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

2008 - 20th Annual West Coast Tour
Online Registration Form
(Note: * Required Field)

Participant Information
*First Name		*Last Name
*Name you want to be called
*Address 1		Address 2
*City		*State
*Country		*Zip
*Telephone		*E-Mail Address
*Date of Birth		Male	Female
"T" Shirt Size	S M L XL

Rotary Host - YEO or Counselor Information
*Host Rotary Club		*District No.
*Rotary Counselor First Name		*Rotary Counselor Last Name
*Counselor Address 1		Counselor Address 2
*City		*State
*Country		*Zip
*Telephone		*Email

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

*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$1,470 in full, or the deposit of $350.00, 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.
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 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 $350.00 or US$1,470.00 to West Coast Tour and mail to:

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

I will pay by Check Credit Card