DAY TRIP TO SRI RAJARAJESWARI TEMPLE

day TRIP TO SRI RAJARAJESWARI TEMPLE

* Indicates required field

Participant 1 *

First

Last

Phone Number *

Participant 2 First and Last Name *

PHONE # - PARTICIPANT 2 *

Emergency Contact Person's Name *

Emergency Contact Person's Phone# *

Tickets *

Cost Per Person $60

Ages *

AGE 55-64 65 years and older Age 18 - 54 Age 17 & under

Trip Requirement *

Canadian Citizen PR card holder - Please bring the passport with American visa

Email *

Please note *

DTA also strongly suggests all passengers to take their own out-of- country medical insurance. DTA is not responsible for medical insurance.

Payment *

I have e-Transferred the ticket funds to [email protected]

Drop-off/Pick-up Location *

AJAX SCARBOROUGH

Comments - Please add all attendees name & Phone #s *

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