USA Student Travel - FL Itinerary & Registration Template

DATE/TIME ACTIVITY ADDITIONAL INFORMATION Wednesday, March 16, 2016 Meet after A lunch to depart for Florida Via motorcoach 11:00 am Arrival at hotel

Thursday, March 17, 2016 Breakfast included At hotel ® Disney Park Hopper includes Magic KingdomPark, Disney Theme Park time ® Epcot , Disney’s Hollywood Studios™, and Disney’s Animal ® Kingdom Theme Park Disney Dining Card Lunch included Disney Dining Card Dinner included Friday, March 18, 2016 Breakfast included At hotel Universal Orlando 1 Day/2 Park ticket to Universal Studios Resort and Islands of Adventure Lunch included Universal Meal Voucher Dinner included Universal Meal Voucher Saturday, March 19, 2016 Breakfast included At hotel

Disney Theme Park time See Thursday for options

Lunch included Disney Dining Card Dinner included Disney Dining Card Sunday, March 20, 2016 Breakfast included At hotel Checkout and depart for home. Via motor coach *Schedule / Order of events subject to change Estimated Package Price: $797.00 based on a minimum of 35 paid participants per bus, roomed quad Payment Dates: June 5, 2015 ($100), July 5, August 5, September 5, October 5, November 5, December 5—($100 payment each month) January 5, 2016 (Final Balance $97)

Registration & Payment Form: (all Fields Required)

Name of School or group you are travelling with: ______

Traveler Full Legal Name:______

Mailing Address: ______City: ______State:______Zip Code______

Male or Female Date of Birth ______Phone Number (______)______Email #1 ______I hereby consent to my child, if under the age of 13, to register at your website www.usastudenttravel.com pursuant to your Terms of Service and Privacy Policy. I further consent to your collection, use and disclosure of my child’s personally identifiable information, pursuant to the terms of, and as fully described in, the Privacy Policy. I hereby consent to the potential for price increases as set forth in §5 and §9. I HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS OF THIS TOUR PARTICIPANT AGREEMENT INCLUDING USE OF PHOTO AND LIKENESS IN ACCORDANCE WITH §17. I ACKNOWLEDGE THAT I HAVE MADE ALL DISCLOSURES IN ACCORDANCE WITH §16. Signature of Legal Guardian/Parent: ______Date: ______Payment Information: : (Make Payable To USA Student Travel) Amount to charge ______ E-Check:  I (we) hereby authorize WORLDPASS TRAVEL GROUP to initiate a debit entry to my (our) Checking Account indicated below at the depository financial institution name below, hereinafter called DEPOSITORY, and to debit the same to such account. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law. Name on Checking Account ______Checking Account Number ______Billing Zip Code ______Bank Name ______Bank Routing Number ______ Credit Card: Prices reflect a discount for payment by cash (check, e-check, cash, money order). A non-cash payment fee of $15.00 (one time only) will be added to the current cash discounted price when using other forms of payment. Credit Card Number: ______Expiration Date: ______CVC #: ______Billing Zip Code: ______Name of Cardholder (PRINT): ______Signature: ______NOTE: E-Check and Credit card statement charges will appear as WorldPass Travel Group USA Student Travel 5080 Robert J Mathews Parkway, El Dorado Hills, CA 95762. www.USAStudentTravel.com USA Student Travel is a division of WorldStrides.