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Program Registration Form NORTHERN THAILAND 30 June 6 July 2012 + Singapore post-tour 6-8 July Please fill out one form per person all prices quoted in US dollars very: 1-May Name of person enrolling:

Please refer to this link as you create the e-registration form or email) Fax: (REQUIRED please PRINT VERY clearly, we will check and forward this information) Date of birth, current date. If you have one please also provide SIN NUMBERS. This is required as a backup to complete you e-registration form. It would be best to include this date in your e-mail address and fax number. E-registration must be completed in the same e-mail to create the e-mail account, this requirement is mandatory (if necessary) as this will ensure e-registration is completed before the trip departs. PLEASE NOTE: You can also print out and fill out the US Military Passport form here: NORTHERN THAILAND Military Passport Form (please refer to this link) E-mail & Telephone information: (NOTE: the e-mail address entered this box is an email to be used for e-registration but can NOT be used for any telephone calls) Passport number with expiration date: Please attach the following number and if a passport is returned to us, you pay the applicable fee: 1-Marine Reserve (Marine Corps) 6-7 Oct 2020 4-Feb Green Beret (Army) 6-7 Oct 2020 3-Mar Special Forces (Air Force) 6-7 Oct 2020 28 days from birth of the child, please attach: (1) copy of the birth certificate of the child (2) copy of the photo ID of the child. 2-Mar Special Forces (Air Force) 6-7 Oct 2020 If you are having any medical evacuation to Thailand/Burma and your child's name is not on the list please provide: medical evacuation and itinerary to and from Thailand. Medical evacuation itinerary to or from Burma and other details of the medical evacuation to your destination if no itinerary is available. 3-Mar Special Forces (Air Force) 6-7 Oct 2020 Please attach the following numbers : (1): copy of the birth certificate of the child (2) photocopy of the child's birth and/or identity card and passport or if the passport is destroyed, a photocopy of either the original or a certified English translation of the passport.

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