REFERER
Upon receipt of application, an office staff member will contact you within 10 business days to verify information.



eg: 111-111-1111

eg: xxx@ggg.com

We do not mail any information to your address without your concent.




PARTICIPANT
Tell us a little information about the participant and what is their dream adventure.


Private With a group

Yes No

Yes No

Yes No We may provide airline tickets for the participant, their caregiver, if needed, and one adult person over the age of 18.



Yes No We may provide hotel accomodations for the participant, their caregiver, if needed, and one adult person over the age of 18.