PASSENGER NAME(S):

 

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EMAIL:  _____________________________________________________    CELL/TEXT:___________________________________________

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CITY & STATE FROM WHICH YOU ARE ARRIVING:______________________________________________________________________

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​DO YOU HAVE ANY SPECIAL DIETARY REQUIREMENTS OR LIMITATIONS?  If so, please note below or on reverse side.

 

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DEPOSIT ($1,000 per person) ENCLOSED  $______________________       CHECK NUMBER: _________________

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Please make check payable to:     Phyllis Tate 

and MAIL WITH THIS FORM to:     P.O. Box 71027

                                                       Fairbanks, AK 99707

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EVIDENCE OF COVID-19 VACCINATION(S) FOR ALL PASSENGERS IS ENCLOSED. ________________________________________                                                                                                                                                     Signature of Applicant(s)

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