Trip Application and Deposit Form

Personal Data

* Indicates required field

Name (as it appears on your passport) *
Address *
City * State * Zip *
Email *
Fax *
Best number to contact you at: * Age * Sex * Height
Weight Smoker * Occupation * State of Health *
Do you have any health conditions of which we should be aware? If yes please explain.

Do you have a current valid passport? *
If you do not have a current valid passport one is required before traveling to Thailand.
Passport# : *	Issue Date: *	Expiration Date: *
Place of Issue: *		Citizenship *
Date of Birth : * Place of Birth : *
Emergency Contact (include address and phone number)

Experience (Relevant to the trip applied for, enter "None", "Limited", "Moderate" or "Extensive")
Scuba Diving Sailing Golf
Describe your overseas travel experience:

How did you hear about My Fantasy Camp™ *

Note that My Fantasy Camp™ will not share this information with any outside sources.
Phone: 760-632-0650