Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Birthdate *

MM

DD

YYYY

Non-Refundable Payment *

By checking the box I agree and understand that my $500 deposit is 100% NON-REFUNDABLE.

Airfare Policy *

By checking the box I agree not to purchase my airfare until explicitly told to do so in writing by Alchemy Adventures. By checking this box, I also acknowledge that if I purchase airline tickets prior to being instructed to do so and the trip is cancelled, Alchemy Adventures will not be held liable for money spent on airline tickets.

Double Occupancy Agreement *

By checking this box, I acknowledge that the price of this trip is based on double occupancy (i.e. that I will have a roommate throughout trip). I also acknowledge that if I would like my own room, I will request so in writing and that single rooms are available on a first-come, first-served basis for an additional fee.