Travel Reservation Form
Hypnotic Research Society

• Name:
• E*mail:
• Your Mailing Address:
• Sacred Journey: Check the journey you want to register for.
  Peru - Inka Trail (June 2008) $4295 per person double occupancy
  
• Payment Method: Check payable to HRS VISA MasterCard
  or use PayPal

  Note: this is not a secure order form. If you would like us to phone you to get your card numbers, enter your phone number here:
  Phone and Area Code:

• Please note a deposit of $500 is needed to hold your place. Payment in full by two weeks prior to departure..
• Room Mate Choice: Please check all that apply
  Already have a room mate
  Prefer nonsmoker
  I am male I am female
  I am under 35 I am 36-55 I am over 56
  

  Note: you need a room mate. If you would like us to pick one for you, please select your choices above. If no one is available to be matched with you, you will pay the single rate.

• Comments or Questions:

Thank You! Press SUBMIT once to send the form.