Print and mail this form to register (we need a copy of your signature with
your deposit).

Name(s) as on passports : ___________________________________   

Address: ______________________________________________
 _____________________________________________________ 

Day Phone: ________________ Evening Phone: ______________

This reservation is for ____ person(s), and I (we) wish to share a room
with ____ other person(s). Please consider the criteria below for my (our) 
roommates. (You may specify roommate(s) by name, or we can match 
people by sex & smoking preference.) 
_______________________________________________________ 
_______________________________________________________ 

Joining expedition at: Wash., DC ___ New York ___ Los Angeles ___   
Johannesburg (land expedition only) ___ Other ___________ 

Short program (w/o 1st 2 days) ___ 

Need assistance with connecting flights?
From ________________ to ___________   

Extension trips? Special meals?: Comments? _____________________
_______________________________________________________
_______________________________________________________

Registration fees: ____ persons at $900 per person (full program) or 
$500 pp (ground program) Total: $__________ 

Credit card coupon for payments: 
Payments may be made via check or money order drawn on a U.S. bank, 
or by Visa or MasterCard credit card. Your authorization for credit card 
payment may be made by phone (360/504-1169), fax (866/758-3792), 
mail (this form), or E-mail (tomvf@metaresearch.org). For credit cards 
only, please include the following: 
_________ ________________ _________ ___________________  
   Amount         Credit Card #        Exp. Date         Signature 

For Persons Not Registering At This Time: I wish to remain on your 
mailing list for additional bulletins about Eclipse Edge Expedition Z’01. 
I enclose $20, creditable toward the registration cost if I join later. 
(Future expedition announcements are free.) Total: $__________
“I have read and understand the disclaimers for this expedition, and I 
(we) agree to those conditions.” 

Signature: ______________________________ 

SEND THIS FORM with deposit to:

Eclipse Edge Expeditions Z’01 
PO Box 15186
Chevy Chase, MD 20825-5186