RESERVATION FORM LUNEBURG, Germany SPRING 2013 Semester Frosch Student Travel 700 Airport Blvd. Ste. 360 Burlingame, CA 94010 Fax: 650-579-0811 Tel: 1-800-592-2887 mailto:studentinfo@frosch.com Please submit this form no later than October 05, 2012 TRAVEL INFORMATION I will participate on the USAC group flight to Germany. Departure options: San Francisco — $1459 (subject to availability) Chicago — $1399 (subject to availability) Other I would like to depart from an alternate city to merge with the group from (Please specify city or airport name and date of departure) Airfares available from various cities. Please continue to complete the reservation form. Your card will not be charged until you receive a fare quote. We will contact you regarding the fare upon receipt of your form. Return options: I would like to return with the group from Hamburg on April 29, 2013 I would like to return with the group from Hamburg on an alternate date - (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 ALABAMA (AL) ALASKA (AK) AMERICAN SAMOA (AS) ARIZONA (AZ) ARKANSAS (AR) CALIFORNIA (CA) COLORADO (CO) CONNECTICUT (CT) DELAWARE (DE) DISTRICT OF COLUMBIA (DC) FEDERATED STATES OF MICRONESIA (FM) FLORIDA (FL) GEORGIA (GA) GUAM (GU) HAWAII (HI) IDAHO (ID) ILLINOIS (IL) INDIANA (IN) IOWA (IA) KANSAS (KS) KENTUCKY (KY) LOUISIANA (LA) MAINE (ME) MARSHALL ISLANDS (MH) MARYLAND (MD) MASSACHUSETTS (MA) MICHIGAN (MI) MINNESOTA (MN) MISSISSIPPI (MS) MISSOURI (MO) MONTANA (MT) NEBRASKA (NE) NEVADA (NV) NEW HAMPSHIRE (NH) NEW JERSEY (NJ) NEW MEXICO (NM) NEW YORK (NY) NORTH CAROLINA (NC) NORTH DAKOTA (ND) NORTHERN MARIANA ISLANDS (MP) OHIO (OH) OKLAHOMA (OK) OREGON (OR) PALAU (PW) PENNSYLVANIA (PA) PUERTO RICO (PR) RHODE ISLAND (RI) SOUTH CAROLINA (SC) SOUTH DAKOTA (SD) TENNESSEE (TN) TEXAS (TX) UTAH (UT) VERMONT (VT) VIRGIN ISLANDS (VI) VIRGINIA (VA) WASHINGTON (WA) WEST VIRGINIA (WV) WISCONSIN (WI) WYOMING (WY) ----------------------------------- Armed Forces Africa (AE) Armed Forces Americas (AA) (except Canada) Armed Forces Canada (AE) Armed Forces Europe (AE) Armed Forces Middle East (AE) Armed Forces Pacific (AP) (required) Zip/Postal Code(required) Country United States United Kingdom Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic of The Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierreand Miquelon Saint Vincent and The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and The South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Timor-leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zambia (required) Daytime Phone(required) Evening Phone(required) Mobile Phone Email Address(valid email required) PASSPORT INFORMATION First Name(required) Middle Name(required) Last Name(required) Date of Birth Date Of Birth(month) Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec (required) (date) Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 (required) (year) Year 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 (required) Gender Female Male (required) Citizenship Passport Number Passport Issuing Country United States United Kingdom Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic of The Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierreand Miquelon Saint Vincent and The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and The South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Timor-leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zambia Passport Expiration Date Passport Expiration Date(month) Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec (date) Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 (year) Year 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 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 Visa MasterCard Amex Discover Card Number Exp. date Expiration Date(month) Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec (year) Year 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 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 Please select ALABAMA (AL) ALASKA (AK) AMERICAN SAMOA (AS) ARIZONA (AZ) ARKANSAS (AR) CALIFORNIA (CA) COLORADO (CO) CONNECTICUT (CT) DELAWARE (DE) DISTRICT OF COLUMBIA (DC) FEDERATED STATES OF MICRONESIA (FM) FLORIDA (FL) GEORGIA (GA) GUAM (GU) HAWAII (HI) IDAHO (ID) ILLINOIS (IL) INDIANA (IN) IOWA (IA) KANSAS (KS) KENTUCKY (KY) LOUISIANA (LA) MAINE (ME) MARSHALL ISLANDS (MH) MARYLAND (MD) MASSACHUSETTS (MA) MICHIGAN (MI) MINNESOTA (MN) MISSISSIPPI (MS) MISSOURI (MO) MONTANA (MT) NEBRASKA (NE) NEVADA (NV) NEW HAMPSHIRE (NH) NEW JERSEY (NJ) NEW MEXICO (NM) NEW YORK (NY) NORTH CAROLINA (NC) NORTH DAKOTA (ND) NORTHERN MARIANA ISLANDS (MP) OHIO (OH) OKLAHOMA (OK) OREGON (OR) PALAU (PW) PENNSYLVANIA (PA) PUERTO RICO (PR) RHODE ISLAND (RI) SOUTH CAROLINA (SC) SOUTH DAKOTA (SD) TENNESSEE (TN) TEXAS (TX) UTAH (UT) VERMONT (VT) VIRGIN ISLANDS (VI) VIRGINIA (VA) WASHINGTON (WA) WEST VIRGINIA (WV) WISCONSIN (WI) WYOMING (WY) ----------------------------------- Armed Forces Africa (AE) Armed Forces Americas (AA) (except Canada) Armed Forces Canada (AE) Armed Forces Europe (AE) Armed Forces Middle East (AE) Armed Forces Pacific (AP) New FieldZip/Postal Code Country Please select United States United Kingdom Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic of The Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierreand Miquelon Saint Vincent and The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and The South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Timor-leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zambia 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.