Registration - northern Italy 2023

Name (as it appears on your passport

First Name

Last Name

Date of birth

MM

DD

YYYY

Passport Number

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email

Roomate Name (as it appears on their passport)

First Name

Last Name

Roomate Date of Birth

MM

DD

YYYY

Roomate Passport Number

Roomate Address

(if different from above)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Roomate Phone

(###)

###

####

Roomate Email

Method of Payment

Payment by credit card will result in a 4% convenience fee

Check

Credit Card

If payment by check please include the check number below and mail in care of Larry Fannon, 1239 Weber Road, Loveland, OH 45140. If paying by credit card, please add number, expiration, and CVV below.

Emergency Contact

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email