W&L Forms Builder

FLAVORS OF PROVENCE
(October 2-10, 2024)

* GUEST 1: Full Name as it appears on your passport (First / Middle / Last)

* Preferred Name for name badge:

MAILING ADDRESS:

* Street:

* City, State & Zip:

* Email:

* Mobile Number:

* Birthdate and Age:

* W&L Affiliation (Class Year, Parent (Year), Friend):

If you have any mobility concerns, please list here:

GUEST 2: Full Name as it appears on your passport (First / Middle / Last)

Preferred Name for name badge:

MAILING ADDRESS (if different than listed under Guest 1):

Street:

City, State & Zip:

Email:

Mobile Number:

Birthdate and Age:

W&L Affiliation (Class Year, Parent Year, Friend):

If you have any mobility concerns, please list here:

If you are traveling with others not listed on this form, please provide their name(s):

Will you be celebrating a special event during the trip (birthday, anniversary, etc.)? Please provide the date.

Cabin Category Preference

First Choice:

Second choice:

Preferred Method of Payment:

Credit Card

Check (make payable to ORBRIDGE and send to W&L)

I/We have carefully read the Terms and Conditions and Responsibility sections in the brochure and agree to their terms on behalf of myself and the members of my party named above.