Pre-Conference Tour & Conference April 20-May 1, 2017
or Conference only April 26 to May 1, 2017
or Cambodia Tour Only April 20-25

Please submit a separate form for each traveler

After you complete and submit this form, you will automatically be re-directed to the Payment Page, with instructions on how to pay securely online by credit or debit card. Advance payment in full is required to reserve your space on this tour.

NOTE: The name you enter below must be exactly as it appears or will appear on your passport. If you do not have a passport at this time, please submit this form now and provide BMSJ with your passport information after you receive your passport. Your passport expiry date should be more than six months after the ending date of this tour.

First Name (required)

Middle Name (if applicable)

Last Name (required)

Passport Number

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Passport Issue date

Passport Expiry date

Date of Birth (required)

Country of Birth (required)

Mailing Address (required)

City (required)

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Your Email (required)

(Required) I am: FemaleMale

(Required) I am registering for:
Pre Tour & Conference April 20-May 1Angkor Wat Tour Only April 20-25Conference Only April 26-May1

I have physical limitations that require special attention. I am entering details in the "Optional Message" area below. (Most situations can be accommodated, but we must know beforehand in order to make arrangements, and there may be additional costs.)

I require a special diet and am entering details in the "Optional Message" area below.

(Required) I am requesting: Double AccommodationsSingle Accommodations

(Optional) My roommate will be:
I do not have a roommate and I understand Body Mind Spirit Journeys will try to match me with a suitable roommate.

Optional Message

Body Mind Spirit Journeys highly recommends the purchase of Trip Cancellation Insurance, and our preferred Insurance provider is Allianz.

(Required) I understand and accept the Terms and Conditions for this program. I understand some or all payments made may be forfeited, based on my cancellation of this program as detailed within the Terms and Conditions linked from this reservation form. Should this trip be cancelled by Body Mind Spirit Journeys, all payments received will be refunded.
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