Registration for Eclipse Edge Expedition Z‘01

Print and mail this form to register (we need a copy of your signature with your deposit).

Name(s) as on passports : _______________________________________________________________

Address: ________________________________________________________________________________

_________________________________________________________________________________________

Day Phone: ____________________ Evening Phone: __________________

This reservation is for ____ person(s), and I (we) wish to share a room with ____ other
person(s). Please consider the criteria below for my (our) roommates. (You may specify roommate(s)
by name, or we can match people by sex & smoking preference.)

__________________________________________________________________________________________

__________________________________________________________________________________________

Joining expedition at: Wash., DC ___ New York ___ Los Angeles ___

Johannesburg (land expedition only) ___ Other ___________

Short program (w/o 1st 2 days) ___

Need assistance with connecting flights?

From ________________ to ___________

Extension trips? Special meals?: Comments? _____________________

_________________________________________________________________

_________________________________________________________________

Registration fees: ____ persons at $900 per person (full program) or $500 pp (ground program)
Total: $__________

Credit card coupon for payments:

Payments may be made via check or money order drawn on a U.S. bank, or by Visa or MasterCard
credit card. Your authorization for credit card payment may be made by phone (360/504-1169)
fax (866/758-3792), mail (this form), or E-mail (This email address is being protected from spambots. You need JavaScript enabled to view it.). For credit cards
only, please include the following:

____________ ___________________ ____________ ______________________

   Amount      Credit Card #      Exp. Date      Signature

For Persons Not Registering At This Time: I wish to remain on your mailing list for additional
bulletins about Eclipse Edge Expedition Z’01. I enclose $20, creditable toward the registration
cost if I join later. (Future expedition announcements are free.) Total: $__________
“I have read and understand the disclaimers for this expedition, and I (we) agree to those conditions.”

Signature: ______________________________

SEND THIS FORM with deposit to:

Eclipse Edge Expeditions Z’01
PO Box 15186
Chevy Chase, MD 20825-5186