Radical Sabbatical

Registration Form

Thank you for filling out the form below.
The field marked with (*) are required fields.
Trip Name*	Please select a trip
Full Name*	A value is required.
(as it appears on your passport or drivers license number Passport number)
Date of Birth*	A value is required.Use format mm/dd/yyyy
Drivers license number*	A value is required.
Passport number*
Mailing Address
Phone Numbers
Home
Mobile*	A value is required.
Work
Email Address*	A value is required. Enter valid email.
Describe Health Condition and Physical Limitation:

Special Dietary Request
Special Needs Request
Date of Registration and payment
Deposit $600 registration 90 days before trip Balance due 60 Days before trip

Payment Method
Paypal - www.paypal.com - 6thsensetravel@comcast.net Mail Check - Payable to Community Market Services, Inc. 114 Sumner Road, Annapolis, MD 21401 Invoice to above address

Double or single occupancy
Double Occupancy roommate request Double Occupancy no roommate request Single Occupancy extra $200 - $700 dependent on trip
Please enter the name of your requested roommate

Click here to read Waiver of Liability (Your registration will not be complete until you print, sign, and mail or Fax this waiver to us)
I agree to the waiver of liability and that all of the above information is correct and accurate