Couples and families: One form per person, please.Name (As it appears on your passport) First Middle Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone (Cell)Phone (Home)Email Your Date of Birth MM slash DD slash YYYY Passport NumberPassport Expiration Date MM slash DD slash YYYY Please Select Your Preferences: I would like to register for double occupancy for $5,350 I would like single occupancy ($1,200 additional) I would like to register for the extension trip of $1,150 I would like single occupancy for the extension trip ($270 additional, if available) I owe a different amount (staff will verify this with you). If choosing double occupancy, I and another specific person like to room together (see special note).** Please assign my roommate. If you snore or use sleep equipment, please sign up for a single room, or check this box so we can accommodate you with the appropriate roommate. This will be kept confidential (see special note).** **Special note: If you book a shared room and you or your roommate decides to change to private accommodations, BOTH of you will need to pay the single occupancy rate (provided another room is available). Also, if you request a shared accommodation but there is no one to share with you, you will need to pay the single occupancy rate.Total Amount OwedWho I'd Like to Room WithWhat Is Included in the Price The cost of all hotel lodgings All breakfasts plus 31 lunches or dinners on Main pilgrimage + Extension The cost of all ground transportation All programs, meditations & tours All taxes on the above items What Is NOT Included in the Price Flights to/from India, passport or visa fees Any meals not included during the pilgrimage Any baggage fees or extra baggage fees Any extras (meals, gifts, etc.) Any donations or tips you may wish to leave at the shrines, churches, restaurants, and for porters etc. We usually take a collection at each shrine to give. This is a tradition from India. Personal items, laundry, phone, or any other charges beyond the group’s prepaid hotel rates. Payment In order to reserve your space, please submit a down payment of $1,000 with your reservation form. Early bird discounts: Make your full payment by November 24, 2024, and receive up to a $500 discount.Cancellation Policy If you cancel by March 31, 2025, your payment will be refunded, less a $500 cancellation fee. If we have purchased your flight/s (domestic flights within India), lodging, meals and ground transportation, any applicable cancellation fees will also be subtracted from your refund. After June 30, 2025 sorry but no refunds are possible. We will continue taking reservations, as long as space is available. Space is limited, so we encourage you to register as soon as possible!Payment(s) I have made or will make a deposit of $1,000 I have paid the full amount or will pay in full I have a remaining balance due; 50% due March 31, 2015; 50% due Aug 31, 2025 The Full Amount That I've Paid or Will PayMy Remaining Balance AmountHow to Make a Payment Please contact the Ananda Washington Sangha office to make arrangements. Email us at: friends@anandawashington.org Call: (425) 806-3700 Mail a check to: Ananda23305 Bothell-Everett HwyBothell WA 98021 *The use of credit cards will require a 3% additional credit card fee.Emergency Contact (Name) First Last Emergency Contact (Phone)Emergency Contact (Relationship)Agreement Ananda Washington is acting as your coordinator only with regard to transportation and accommodations. We will of course exercise every possible care for your safety, but we cannot be held responsible for personal injury, property damage, stolen items, or inconvenience caused by suppliers of any services being offered on this pilgrimage. We are not responsible for delays, accidents, or changes that must be made due to events beyond our control. I understand and agree to the above.Your Signature (Type your name)Date MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged.