Chiang Mai, Thailand Fall 2024 Semester FORM

Travel Information

Group Flight *

I will participate on the USAC group flight to Chiang Mai.

Departure Options *

Los Angeles – $ 1,199.00

Return Options *

I would like to return with the group from Chiang Mai on Dec/14/2024
I would like to return with the group from Chiang Mai on May/10/2025
I would like to return on an alternate date or from a different destination

From *

Return Date *

Special Meal Request (if any)

Contact Information

Mailing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Email *

Passport Information

Name *

First

Middle

Last

Date of Birth *

Gender *

Male
Female
Other
Prefer not to say

Citizenship *

Passport Number *

Issuing Country *

Expiration Date *

Payment Information

Payment Method *

Credit Card

Your credit card will not be charged until you have reviewed and approved the itinerary and airfare.

Type of Card *

Visa
Mastercard
Amex

Name on Card *

Card Number *

Expiration Date *

Security Code *

Billing Address

Billing Address Same as Mailing Address

Billing Address is same as mailing address

Address *