Mount Shasta Registration Form To hold your spot we must have this completed form and payment of your $800 non-refundable deposit. Email* Preferred Name*This will be used on your name-tag. 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Home PhoneBe sure to include your country code. Room Preference - based on availability, prices subject to change*Please indicate your preference. Room choices are very limited and will be allocated on a 1st come, 1st served basis. Due to the unique configurations of the rooms, we may be unable to accommodate singles requests or original preferences. Please contact Susan@JonetteCrowley.com with questions Shared Room, 2 Queen Beds $0, base price 'Couple A' Jacuzzi Room, King bed (5 available) $130 'Couple B'- 1 Bdrm Chalet, King bed (4 available) $194 Triple - 2 Bdrm Chalet , 1 Double, 1 King - $160 Singles (if available) $206-$388 Name of RoommateWe will select a roommate if needed. Food Preferences*We will inform the hotels and restaurants of your preferences and will do our best to accommodate your dietary needs and preferences. None Vegetarian Fish OK Vegan Gluten Free Poultry OK Dairy Free Facebook NameYour full name as it appears on Facebook so we can add you to our Mount Shasta Private Group. Leave blank it you do not have a Facebook account Emergency Contact Name* Emergency Contact Phone Number*Be sure to include your country code. HiddenPASSPORT INFORMATIONHiddenFULL Passort NameEXACTLY as on passport. We cannot purchase air tickets if the name is not complete. HiddenPassport Number HiddenNationality as stated on passport HiddenPassport Expiration dateWrite out the full month name. Gender*FemaleMaleHiddenDate of BirthWrite out the full name of the month. HiddenDate of BirthMonth/Day/Year Month Day Year Payment Options*Check all that apply: *Totals are based on double occupancy. Regular Price $2,928 - Due February 28, 2019 Early Bird Option - $2,728 - Due Nov 30, 2018 Room Upgrades - $103-$388, price TBD based on availability Cash/Check Discount - $80 discount for payment by US check Direct Deposit Discount - $40 for USD wire transfer to our US bank Signature*I intend to fully participate in this Tibet Spiritual Tour. I understand that spaces are subject to availability and my registration is not considered complete until receipt of the non-refundable $800 deposit AND this completed registration form. (Please use your computer mouse to sign in the box below.)Printed Name*Printed Name from above signature First Last Date Signed* Month Day Year
