Enrollment Information

I understand that the land portion of this trip and the airline ticket are non-refundable. Unless I purchase the trip interruption/trip cancellation insurance that has been offered to me, I will be unable to get any money back should I be unable to begin travel or need to interrupt my trip. This includes circumstances such as the airline flight being cancelled and the trip delayed or extended, I or a family member becomes ill, I'm in a wreck on the way to the airport, or any other circumstance. I acknowledge that I and others on the trip have been offered the opportunity to enroll in trip cancellation/trip interruption insurance and I am assuming all responsibilities should I not do so. Enrollment for trip cancellation/interruption insurance can occur at http://www.distinctive-destinations.com/Ghanastudytrip.html

* Required fields
Name *
E-mail Address *
Name as on Passport: *
Mailing Address: *
City: *
State: *
Zip: *
Home Phone: *
Work Phone:
Mobile Phone:
Gender *
Age and Date of Birth *
Room type: *
If double room, name of roommate:
Country of passport: *
Passport number: *
Passport issuance date: *
Passport expiration date: *
Insurance beneficiary:
Special requests:
Date of submission: *

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