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

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