Nagasaki, Japan FALL 2022 Program FORM

Travel Information

Group Flight *

I will participate on the USAC group flight to Fukuoka

Departure Options *

Los Angeles (ticket valid 6 months) – $ 1,799.00
Los Angeles (ticket valid one year) – $ 2,599.00

Connecting Flight

I would like to book a connecting flight

From *

Please note, add-on airfare is extra and will be quoted to you. Please continue to complete the reservation form. Your card will not be charged until you receive a fare quote for the add-on. We will contact you regarding the additional fare upon receipt of your form.

Return Options *

I would like to return with the group from Fukuoka on Feb/11/2023
I would like to return with the group from Fukuoka in Early-August/2023 (TBD)
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 *

Check
Credit Card

Please make checks payable to “Frosch Student Travel” and mail them to the address listed above.

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

Type of Card *

Visa
Mastercard
Amex
Discover

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 *