Ithaca in Dijon - May 2009
(Do not use ENTER key until ready to submit form)

Name   
           EXACTLY as it appears on passport

Nationality     Passport Number

School Address    City/State/Zip   

Home Address    City/State/Zip

Home Phone    School Phone    Cell Phone                    

Email Address

Frequent Flyer Information

Continental  Northwest   Delta    

Special Meal/Dietary Requirements

Salt Free            Kosher            Vegetarian           Other

If you need any type of deviation from the scheduled flights, please contact
me directly by phone or e-mail to discuss.

All Flights Are Non-Smoking

Please Make Check Payable to Baker Travel and mail Check to:
Marcia Ervay
1146 Danby Rd
Ithaca, New York  14850