ENROLLMENT FORM

2014/2015 EF Explore America
PLEASE ASK YOUR GROUP LEADER TO EITHER AFFIX LABEL HERE OR FILL OUT THE FOLLOWING:
ENROLLMENT FORM
Tour # (required for processing enrollment form):
Tour name and requested travel date and year:
Group Leader:
A non-refundable $99 Enrollment Fee must be paid at the time of enrollment.
TRAVELER INFO
(Group Leaders should not fill out an enrollment form for themselves.)
IMPORTANT! IF TRAVELING BY AIR, PROVIDE YOUR COMPLETE NAME AS IT APPEARS ON YOUR TRAVEL CREDENTIALS (E.G., BIRTH CERTIFICATE, PASSPORT OR STATE-ISSUED IDENTIFICATION).
Legal first name:
(No nicknames. i.e. Robert, not Bobby. IMPORTANT! $100 minimum penalty for name change.)
Middle name:
(Provide only if included on your photo identification. If your photo identification displays a middle initial, list only a middle initial here. Your name must be an exact match.)
Last name:
Date of birth:
Gender:
MM
DD
Male
Female
Are you a U.S. citizen?
Yes
No
Optional: For travel to Canada, we will use this to provide you
the most accurate information on passport/visa requirements.
YY
Traveler’s Email:
Mailing address:
City:
State:
Home telephone:
Prefiero comunicación en español cuando esté disponible.
EMERGENCY CONTACT INFO
(NOT TRAVELING ON TOUR) REQUIRED FOR ALL TOUR COMMUNICATION AND IN CASE OF EMERGENCY.
First Name:
Gender:
ZIP:
Last Name:
Male
Female
Prefiero comunicación en español cuando esté disponible.
Check one:
Parent
Guardian
Relative
Spouse
Friend
Contact Email:
(Email of person not
traveling on tour.)
Home telephone:
TRAVEL PROTECTION
Mobile telephone:
Yes, enroll me in the Anytime Protection Plan (May not be added after enrollment)
SEE P. 8 FOR DETAILS.
PAYMENT INFO
Total amount to be processed at time of enrollment: ($99 minimum) $: ________________________
Billing information:
IF YOU ARE NOT PAYING IN FULL TODAY, CHOOSE ONE OF THE FOLLOWING PAYMENT PLANS:
Automatic Payment Plan - Free
Account/cardholder’s name: __________________________________________________________
Select your monthly charge date:
Billing address if different from traveler address:
Additional dates and bi-weekly options are available after enrollment. Call 888-333-9756.
7th
14th
21st
26th
_______________________________________________________________________________
IF PAYING BY CHECKING ACCOUNT, PLEASE PROVIDE:
Billing email: _____________________________________________________________________
Bank routing number: ____________________ Checking account number: ____________________ Account/cardholder’s signature: ________________________________________________________
IF PAYING BY ATM/DEBIT CARD (CARD MUST DISPLAY VISA OR MASTERCARD LOGO), PLEASE PROVIDE:
Please do not enroll me in paperless billing. I want to receive bills by mail.
ATM/debit card number: ____________________________________________________________
Billing ZIP code: ______________________________________ Expiration date: ________ / ________
CHOOSE TO PAY IN FULL TODAY OR SELECT ONE OF OUR PAYMENT PLAN OPTIONS TO THE RIGHT.
Pay in full today
Manual Payment Plan - $40 plan fee
IF PAYING BY CHECKING ACCOUNT, PLEASE PROVIDE:
IF PAYING BY ATM/DEBIT CARD OR CREDIT CARD (CARD MUST DISPLAY VISA OR MASTERCARD LOGO), PLEASE PROVIDE:
Bank routing number: ____________________ Checking account number: ____________________ ATM/debit card or credit card number: _________________________________________________
IF PAYING BY ATM/DEBIT CARD OR CREDIT CARD (CARD MUST DISPLAY VISA OR MASTERCARD LOGO), PLEASE PROVIDE:
Billing ZIP code: _____________________________________ Expiration date: ________ / ________
ATM/debit card or credit card number: __________________________________________________
Billing ZIP code: ______________________________________ Expiration date: ________ / ________
Your enrollment form must be signed below by you, and if the applicant is under 18, by your parent/guardian.
I have completely read and fully understand the “Release and Agreement” and “Booking Conditions” as supplied herewith, and incorporated herein by reference and agree to be bound by, and to comply with the
“Release and Agreement” and “Booking Conditions.” I have also read and agreed to EF’s Automatic Payment Plan and Anytime Protection Plan terms and conditions. Important Condition: Prices are subject to increase
prior to the time of full payment for reasons including, but not limited to, fluctuations in currency exchange rates, fuel prices, and government-imposed taxes and fees. This condition applies to any tour regardless of
travel date. By signing below, I acknowledge my acceptance of this condition to my purchase.
Date: _____________________________________________
I am the parent or legal guardian of the above (minor) enrollee. I have completely read and fully understand the “Release and Agreement” and “Booking Conditions” as supplied herewith, and incorporated herein by
reference and agree to be bound by, and to cause the above enrollee to comply with the “Release and Agreement” and “Booking Conditions.” If applicable, I have also read and agreed to EF’s Automatic Payment Plan
and Anytime Protection Plan terms and conditions. Important Condition: Prices are subject to increase prior to the time of full payment for reasons including, but not limited to, fluctuations in currency exchange rates,
fuel prices, and government-imposed taxes and fees. This condition applies to any tour regardless of travel date. By signing below, I acknowledge my acceptance of this condition to my purchase.
Signature of parent or legal guardian: ___________________________________________________________________________
Date: ______________________________________________
Cut along dotted line.
Signature of enrollee: _______________________________________________________________________________________