Hummel/Tusculum Registration Form

 

To pre-register for a travel tour, please complete the registration form below and hit Submit. For more information and rates please review our Travel Insurance page.

Fields marked with an * are required for submission.

    Tour Name *

    Room Type *

    Single OccupancyDouble OccupancySingle FullTriple Occupancy

    Your Full Name *

    Title

    NickName(for nametag)

    Spouse's First Name(if traveling)

    Spouse's Title

    Spouse's Nick Name

    Email *

    Telephone*

    Mobile Phone

    Address *

    City *

    State *

    Zip *

    Pastor or Tour Leader

    Smoking preference

    SmokingNon-Smoking

    Type of Accomodation

    SingleRoomate

    Roommate Name

    Need a Roommate?

    YesNo

    Departure Date *

    Departure City *

    Passport Number

    Date of issue

    Expiration Date

    Country

    Date of Birth*

    Emergency Contact Name

    (Not travel companion)

    Relationship

    Emergency Phone

    Frequent Flyer Number

    Freq. Flyer Airline

    Seating Preference**

    AisleWindowCenterBulkheadExit Row

    Special meal Request **

     

    Yes

     

    Travel Insurance*:

    I AM INTERESTED in travel insurance coverageI DO NOT want travel insurance coverageI will submit my decision prior to final payment

     

    Security Code:

    captcha

    Verify Code:

     

    ** Disclaimer: Gomega Travel will make a request, however, we cannot guarantee that your request will be honored by the airline.