Research Trip to Thailand Registration

Hello lovely traveling friends!  Please fill out this form and hit "submit" at the bottom.  A $600 deposit is required to hold your space for this trip.  Deposits and/or full payment can be paid via check sent to The Naga Center - 875 S.E. Park Drive, Portland, Oregon 97080.  Due to extensive credit card processing fees it is requested that all payments be made by cash or check in order to keep the overall cost of the trip down (for safety reasons, please only pay with cash if you are able to hand deliver it).  Full payment must be received no later than July 1st, 2017.  If you are in a country outside of the U.S. (hi Natasha), I will contact you to figure out payment options. 

Name *
Name
Address *
Address
Phone *
Phone
Are you okay with sometimes sharing a room with one of your traveling companion?
Have you been to Thailand before?