|
Preferred Air Departure Cities:
Miami
New York
Los Angeles
Other
|
|
I
do not require air transportation |
|
Preferred
Departure Date from the US (dd, mm, yy)
|
| I
Expect between
to
paid participants & need
free trip(s) for
each
paid participants |
|
I
have escorted a trip to Cuba before: Yes
No
|
| First
Name * |
|
|
Last
Name * |
|
| Organization * |
|
|
Address * |
|
| City * |
|
|
State
Zip
* |
| Telephone
Number |
|
|
Fax |
|
| Email
Address * |
|
|
|
|
|
|
I
will need help obtaining a license for this group
to travel to Cuba (There is a fee for this)
OR
*
|
|
I
already have a license for this group to travel to Cuba
* |
|
|
|
Is
there anything else you would like us to know?
|
|
|
|
|
|
|
| |
|
Please
contact us if you have any
questions. |