Please let this serve as an authorization to charge my credit card in the amount of $____________ for my spring break/summer break travel program payment. 

Your Name: _______________________________________________________________
                                                           (Your name as it appears on your credit card)
Type of Credit Card:  Visa ____    MasterCard____    American Express ____    Discover ____

Credit Card #________________________________   Expiration Date:  __________ 

Code # __________ (this is a 3 or 4 digit number on the back of your card after the last digits of your account)

Signature  ___________________________________________________________
                 (I agree to this charge and understand the travel/tour participant policies and agreements)

Date: ___________   E-mail Address: ___________________@_______________

Address: ______________________________________________________________
(this address must be the billing address for the credit card holder)

City:________________________ St. __________  Zip __________

Phone Number: (_____) ______-_________   Emergency Number:   (_____) ______-__________
                                  (Your number at school)                                       (This number can be your cell phone, Mom/Dad, best friend, etc.)
     By signing this form, I agree that I (and all other travel participants that the above payment includes) have read and understand the travel/tour participant agreements for these packages located at www.hotspringbreaks.com or  www.graduationtrips.com   websites.  I understand and agree to these terms and expressly waive any rights to credit card charge backs as a means to mediate disputes.
    Credit Card Payments: All prices listed on our  brochure or quoted by our office reflect a discount for payment via check or money order.  All other forms of payment such as credit cards must add $25 per person to all prices. All credit card payments must be accompanied by the Credit Card form.  NO CREDIT CARD PAYMENTS ARE ALLOWED IN CONJUNCTION WITH COUPONS OR DISCOUNTS!

     Please note:  Spring break travel agreements are located off of the spring break area and are titled "Spring Break Tour Participant Agreement."  The graduation trips or summer break program agreements are located off of the grad trip area and are listed under "Policies".   Room leaders, make sure all of your traveling participants have read in full the above mentioned agreements.  

Students must mail this form to our office. 

If you are making your reservation within 45 days of your departure you must fax your completed/signed form then you must mail as well.
  

  
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Spring Break Area             Grad Trip/Summer Break Area