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Airport Transport Form

February 14, 2012 By Frederick Brace III

DRAGONFLY ADVENTURES

&

VETERANS CAUCUS TRANSPORTATION FORM

 

 

I confirm Dragonfly to make the arrangements for my airport transport.  This form must be filled out with all the appropriate information and returned by November 19, 2010, at the latest.  You MUST mail this form back with credit card information.  Checks not accepted.

 

 

Name(please print)_____________________________________________________

 

Arrival Date:________________           Departure Date:___________________

 

Air Carrier:__________________            Air Carrier:________________________

 

Flight Number:______________            Flight Number:____________________

 

Arrival Time:________________             Departure Time:___________________

 

Number of People:___________             Number of People:_________________

 

Hotel:_______________________            Hotel:_____________________________

 

 

Cost to Gran Melia Puerto Rico Resort:

$50/person/roundtrip

Ages 0-2: Free

 

Visa#___________________________________________Exp Date______________

 

MasterCard_____________________________________Exp Date_____________

 

Signature__________________________________________

 

Return to:

Geisinger Medical Center

CME Office or e-mail cme@geisinger.edu

100 North Academy Avenue

Danville, PA  17822-1350

 

 

 

 

Filed Under: Topics in the Tropics

Frederick Brace III

Frederick Brace III

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Veterans Caucus, Inc is an IRS tax exempt 501 (c) (3) Organization. All donations are tax deductible. EIN # 54-1422270