Go Back

For your convenience, you may also fax the Confidential Information Form to 1-866-201-0510

or mail it to:
Wicked Adventures Travel
P.O. Box 1883
Beltsville, MD 20704

confidential information form

First Name
Last Name
Street Address
City
State
ZIP Code
Country
Date of Birth
Tour Package
Philippines 10 Day
Philippines 5 Day
Thailand 10 Day
Thailand 5 Day
Other
Travel Dates
See our Dates Listing

10 day trips
09/01/05-09/10/05
09/15/05-09/24/05
09/29/05-10/08/05
10/13/05-10/22/05
10/27/05-11/05/05
11/10/05-11/19/05
11/24/05-12/03/05
12/08/05-12/17/05
12/22/05-12/31/05

5 day trips
09/01/05-09/05/05
09/15/05-09/19/05
09/29/05-10/03/05
10/13/05-10/17/05
10/27/05-10/31/05
11/10/05-11/14/05
11/24/05-11/28/05
12/08/05-12/12/05
12/22/05-12/26/05

Other Dates: ______________________
Email Address
Telephone
Fax

Tour Interest

Companion
Yes
No

Gender Preference
Male
Female

Age Preference
12 & under
13-15
16-17
18 & above

Preferred Activities
Special Interests
Please tell us how you
heard about our service
By checking this box, I certify that I am a private individual who desires to travel for personal fulfillment. I am not member of any local, state or federal law enforcement agency of any country.




Go Back

© 2005 Wicked Adventures Travel