NAME_____________________________________________________________
                 Last            First                        Middle

PASSPORT #______________________exp date___________________________
 

ADDRESS__________________________________________________________
                      Street                                         City                                         State/Zip

HOME PHONE_______________fax_________________e-mail_______________
 

Prison Camp and Military Unit___________________________________________
 

Special inflight menu, assistance or seating__________________________________
 

Please indicate medical apparatus accompanying you__________________________

____________________________________________________________________
 

Would you like airport wheel chair assistance?_______________________________
 

Do you wish RAJAH TOURS to arrange your trip to the West Coast?______________
 

Those of you travelling from countries other than the USA please check one of the
following:

__________Yes, I would like RAJAH TOURS to arrange my air plans to Manila
 

__________No, I will make my own air plans
 

If you are interested in side tours after the designated trip ( Ask about our Thailand
Extension Package) - put your choice and your chop below: Thank You