City2City Escapes Registration

PERSONAL INFORMATION
First Name	*
Last Name	*
Home Address	*
City	*
State	*
Zip Code	*
Home Phone
Mobile Phone	*
Email Address	*
DOB (mm/dd/yyyy)	*
EMERGENCY CONTACT (Mandatory)
Emergency Contact Full Name	*
Emergency Contact Phone	*
Relationship (ex: Mother, Father, etc.)	*
AIRLINE INFORMATION
Main Airport
Preferred Airline
ACCOMMODATION TYPE (Mandatory)
Room Type	*
BEDDING	*	ONE KING BED TWO DOUBLE BEDS
ENTER PROMO CODE	*
ROOMMATE(S)
Roommate #1 Full Name
Roommate #2 Full Name
Roommate #3 Full Name
Roommate #4 Full Name
MISCELLANEOUS
T-shirt Size	*
AMBASSADOR	*
I authorize City2City to process and accept my registration for the 2025 Fiesta Soul Weekend.
Electronic Signature	*
Date (mm/dd/yyyy)	*
Security Code	*