Registration Form - Kim's LifeTours

Tour Registration Form

Trip

Tour you are registering for

Your Details

NameStreet Address

City, State

Zip

PhoneEmailBirthdate

Passport #

Expiration Date

Any Chronic/Recurring Health ConditionsAny Dietary RestrictionsHealth Insurance Company & Policy #Contact in Case of Emergency

Room Options

Double:

I would like to share a room. Please enter roommate’s name below.

Roomate’s NameI would like to share a room, if you have a roommate for me. If not, I will pay the single supplement.

Single:

Single room if available (single supplement applies, see trip details for estimated amount)

Total Deposit: $400

Deposit is nonrefundable unless the trip is canceled. Confirmation and payment schedule will be sent after receipt of registration and deposit. Please see complete Terms and Conditions at kimslifetours.com.

Enter your full name as a signature:

Thank you! Your submission has been received!

Pay online with Credit Card

Pay with Zelle

Pay with Check

Please use the number below to pay by Zelle.

715-252-2672

Pay by Check

To complete your payment by check, please email kimslifetours@outlook.com for address.

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Register