2010 ANGKOR WAT MARATHON / HALF MARATHON / 10K TOUR

Please complete the form below (one form per person).  Send along with a copy of your 
passport photopage (if you currently have your passport/otherwise when you obtain 
passport send a copy).
Please make $300.00 deposit check payable to 
Kathy Loper Events, 7801 Mission Center Court, Suite 204, San Diego, CA 92108 
to secure your space on this trip.
Balance due 15 September 2010 (final invoice sent by 01 Sept 2010)

Please Print: (Name as it is or will appear on your passport)

Name______________________________________________________________
	(first)						(last)

Roommate__________________________________________________________

Address:____________________________________________________________

City/State/Zip________________________________________________________

Home Phone (area code/number)_____________________Fax___________________

Business Phone (area code/number)___________________Fax___________________

E-mail:_______________________________________________________________

Age on Dec 05, 2010 (race day) _______	   Birthdate ___MO___Day_____Yr

              Passport #______________		   Expiration Date___Day___ MO____ YR

Cathay Pacific Airlines	Departure City	    Circle One
       Los Angeles  		San Francisco  	    New York JFK  (add $100)
       
Angkor Wat Tour Program A 	Sat 27 Nov-Sun 12 Dec    $4880.00
  Vietnam/Cambodia/Phuket

Angkor Wat Tour Program B 	Sat 27 Nov-Tue 07 Dec   $3690.00
  Vietnam & Cambodia					

Single Room Supplement  Progam A $980.00     Single Supplement Program B $500.00	
Business Class Supplement 	    Ask for details

Travel Protection Plan:  Covers Trip Cancellation, Medical, Emergency Evacuation, Baggage. 
Based on total tour cost & age.  Must be paid within 21 days of initial tour deposit,  cannot be added later.    			

Angkor Wat Event (circle one)	Marathon	   Half-Marathon	   10K      Spectator 

T-SHIRT				S	M	L	XL  (circle one)

Kathy Loper Events		   	619-298-7400                   www.kathyloperevents.com