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
