Application Form

Print out this form, complete it and mail it together with China Tour Features & Condition Form, $200 deposit, and one passport-sized picture, to: East West Exchange, Inc. 4 Commodore Dr. #442, Emeryville, CA 94608

APPLICATION FORM

Name: __________________________________________________

Address: ________________________________________________

City: ____________________ State: _______ Zip: __________

Home Phone: (____)_____________ Sex: ______ Age: ________

Employer: _______________________________________________

Address: ________________________________________________

PHOTO

City: ____________________ State: _____ Zip: __________ Work Phone: (____)___________

EMERGENCY CONTACT: Name: _________________________________

Address: ______________________________ City: ______________ State: _____ Zip: _________

Phone: (___)___________ Relationship: _____________________

Need a single supplement ($500 additional fee) _____ Smoking _______ Nonsmoking ______

Airport you would like to depart _________________________

If the 1^st choice is not available, the 2^nd choice of airport ______________________

SPECIAL NEEDS OR MEDICAL PROBLEMS: _________________________________________

____________________________________________________________________________________

SIGNATURE _______________________________ DATE ___________________________