Please print out this blank form and fill in all the information. Please print clearly.
Be sure to include your $200 (non-refundable) deposit per person with this registration form and
terms & conditions form. The deposit is to confirm your seat or seats.

Checks may be written to Washington Tour.   If you wish to use credit card, call 662-844-5036 ext. 227.

Send your completed registration form and deposit to:

      Washington Tour
      c/o Tim Wildmon
      P.O. Drawer 2440
      Tupelo, MS 38803.

I (We) wish to reserve space for ______ individual(s) on the Washington, D.C. / Mount Vernon Tour.

June 20-23, 2012      September 19-22, 2012

Name(s)
Name(s) on Nametag
Address 1
Apt. #
City/State/Zip
Phone Number	(Home)                                                                        (Cell) Daytime Phone Number is preferred.
E-Mail Address (optional)
	For your space to be reserved you must read and sign terms and conditions page and send in with the Registration Form. Click Here for the Terms and Conditions Form.