IP Madrid, Spain 2015 Program FORM

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TRAVEL INFORMATION

I will participate on the CSU-IP Madrid, Spain program
Departure options:
San Francisco — $1449.00 Los Angeles --- $1449.00 San Francisco departure - $1449.00 (I am a Financial Aid student. Please charge $400 as a deposit now and I will send the balance 2 weeks prior to departure.) Los Angeles departure - $1449.00 (I am a Financial Aid student. Please charge $400 as a deposit now and I will send the balance 2 weeks prior to departure.)
Return options:
I would like to return with the group from Madrid on June 01, 2016 I would like to return on an alternate date from Madrid on-
(Please specify dates)
Meal request if any
(e.g. vegetarian, diabetic, etc)

CONTACT INFORMATION

Please specify the address where you would like to receive information prior to departure including telephone numbers.
Mailing Address(required)
City(required)
State(required)
Zip/Postal Code(required)
Country(required)
Daytime Phone(required)
Evening Phone(required)
Mobile Phone
Email Address(valid email required)

PASSPORT INFORMATION

FORM OF PAYMENT INFORMATION

We accept Check (payable to Frosch Student Travel) & Credit Card payments. If paying by check, please print this form and mail to the address listed above.
Payment Method:
Paying by Check Paying by Credit Card
Type of Card
Card Number
Exp. date
Expiration Date(month)
(year)
Security code (see back of credit card)
Name as appears on card
Billing Address Details:
Click here if Billing Address is same as above.
Billing Address
City
State
New FieldZip/Postal Code
Country
I have read the information listed in the flight memo very carefully and I agree to the terms and conditions of the ticket that I am ordering.