PSC Trip Coupon (One trip per coupon please) 
Name (1):      Member Number:
Smoking:      Non-Smoking

Roommate (2):      Member Number:
Smoking:      Non-Smoking
NOTE:  Name must appear exactly as on driver’s license or passport for overnight trips.

Address (1):   (2):

City (1):     State (1):     Zip (1): -

City (2):     State (2):     Zip (2): -

Home Phone (1):   (2):

Work Phone (1):   (2):

Cell Phone (1):     (2):

E-mail Address (1):   (2):

Birth Date [Required by TSA] (1):   (2):

TRIPS:

  • Mammoth, California, January 7, 2012 – January 14, 2012      Senior, 65+
  • Breckenridge, Colorado, January 28, 2012 – February 4, 2012
  • Jackson Hole, Wyoming, February 18, 2012 – February 25, 2012      Senior, 65+
  • Crested Butte, Colorado, March 3, 2012 – March 10, 2012

Total Enclosed $

Mail coupon and check payable to “PSC” to Trip Contact listed for your trip.
For all trips outside the US, please send a copy of your passport ASAP!
**Be sure to write your name exactly as it appears on your passport or drivers license.
Airline tickets will be issued with the name you provided so please do not use nicknames.
If you didn’t provide an email address, don’t forget to send self”addressed, stamped envelopes for trip confirmation, other trip information and updates!



                         

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