I want to be Exposed!

Name

Spouse / Travel Partner

Address

City

State

ZIP

Home Phone

Work Phone

E-mail

School (optional)

Emergency Contact Name

Emergency Contact Phone

Passport Number

Spouse / Travel Partner Passport Number

Travel Option

Fly with Us - $3100

Fly on your Own - $2200

Departure City

Houston Bush Intercontinental

Washington Dulles

Fly On My Own

Hotel Options

Double Occupancy - No Charge

Single Occupancy - $500

Payment Method

Check / Money Order

Credit Card / PayPal ($100 fee)