Dr. Mr. Mrs. Ms. _____________________________ Birthdate ___________

                                                (Print complete name as shown on your passport)

            Passport No. ____________ Expires _______ Occupation  _____________

(All U.S. citizens require a passport for travel to Japan that is valid three months longer than your scheduled return date.)

Dr. Mr. Mrs. Ms. _____________________________ Birthdate ___________

                                                (Print complete name as shown on your passport)

            Passport No. ____________Expires ________Occupation  ____________   (All U.S. citizens require a passport for travel to Japan that is valid three months longer than your scheduled return date.)

Home Address_________________ City______________  State ___ Zip______

Mailing Address ________________City ______________ State ___ Zip______                                (If final documents are sent by UPS, they cannot deliver to a P.O. box.)

Phone: Home _____________    Business ___________   Cell _______________
Email address: ________________________________Fax: ______________           Note:  When airline reservation is confirmed, we will ask for your airline mileage number so we can insert it into the passenger record for your mileage credit.            

If you arrange your own air, please let us know as soon as possible.  Send us your flight itinerary once it’s confirmed.

Hotel room preference:  Smoking _______      Non-smoking _______   

            Other special requests: _____________________________________________________________

Do you have any special dietary, medical or physical needs of which we should be aware? _____________________________________________________________

Please provide name, relationship, and phone number of person to contact in case of emergency: _____________________________________________________________

If you wish to extend your stay in Japan, let us know how we can help with your arrangements: _____________________________________________________________