December 4 to 11, 2008

 $50.00 per person registration fee must accompany this application and is deducted from the total cost. Balance of fee is required 45 days prior to departure.

Husband and wife may use the same application, enclosing double registration fee.

 Name(s) /   Last Name

Mailing Address

 City      State Pick your state ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING    Zip + 4

Home phone (Area Code)      Cell phone (Area Code) 

Email Address

My choice of departure location  Choose your Departure Springfield, IL, Travelodge, S 6th St. Carlinville, IL, Best Western Staunton, IL, Super 8 O’Fallon IL, Quality Inn St. Louis, Holiday Inn, I-44 & Hampton

Single accommodations requested at $270.00 extra       I am a single traveler, but will accept a same gender roommate.

Triple occupancy discount requested.

I am the 3rd person traveling in the same room with .  Separate application and appropriate deposit required.

My roommate for this trip is       I/We are traveling with friends:

Nick name to use on name tags:               Preference:   Smoking    Non Smoking   

Disabilities limit my walking. Please request lodging staff to place my room near the coach loading area. I do not need a ground floor room if there is an elevator and my room is near it. Request a ground floor room if there is no elevator. I understand Golden Frontier has no control over room assignments assigned by lodging staff.

I have special dietary needs.

     Charge to my Type of Card Master Card Visa Discover                       

 Cardholder’s Name  Statement Address, if different from above 

Zip Code Charge this amount   Card No. (16 digits no spaces)   Expiration Date 01 02 03 04 05 06 07 08 09 10 11 12 2007 2008 2009 2010 2011 2012 2013 2014 2015  

CCID number   As an added security measure, we ask that you enter the last 3 digits on the back of your credit card, on or near the signature panel, called the CCID.

Clicking the submit button will transmit this application and charge authorization to GOLDEN FRONTIER, 4100 N. Illinois St., Swansea (Belleville), IL 62226. Please charge my deposit for this trip to my indicated credit card. Cancellations and requests for refunds must be submitted in writing to Golden Frontier and will be issued in agreement with the cancellation policies of the original trip brochure. I have read the trip brochure and understand the general information, terms and conditions including fees, responsibility, refunds and cancellations, optional trip cancellation and baggage insurance portions of the trip brochure. Confirmation will be sent upon receipt of deposit and application. My electronic application indicates my electronic signature which I authorize to be the same as my original handwritten signature and agreement to the terms and conditions of the trip brochure.

Please accept my application and deposit.