Please fill out the appropriate information and a Phillips Travel Representative will respond to your request promptly! Fields marked with an (*) are required. *First Name: *Last Name: *Title: Please Select One: Band Director Choral Director Music Director Orchestra Director Parent Senior Class Advisor Student Teacher Trip Chairperson *School/Organization: *Phone Number: *Fax Number: *Email: *Street Address 1: Street Address 2: *City: *State: MI AB AK AL AR AS AZ BC CA CO CT DC DE FL FM GA HI IA ID IL IN KS KY LA MA MB MD ME MH MI MN MO MS MT NA NB NC ND NE NF NH NJ NM NS NT NU NV NY OH OK ON OR PA PE PR QC RI SC SD SK TN TX UT VA VI VT WA WI WV WY YT *Zipcode: *Type of Group: Please Select Group Type: Choir Band Orchestra Educational Group Senior Class Youth Group Other *Grade Level: Please Select Grade Level: Elementary Middle School High School Other *Interested In: Please Select One: Boston California Chicago New York Orlando St.Louis Stratford Toronto/Niagara Falls Washington D.C. Williamsburg Other *Other: Preferred Method of Contact: Please Select One: Phone Fax E-Mail Post Office Mail Best time of day to contact? Group Size (minimum of 25) Possible Travel Dates: Indicate by Bus or Air?: Please Select One: Bus Air Special requirements or questions: How did you hear about us?: Please Select One: Referral Online Brochure Other

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