How to submit this form:

Option 1 (Digital): Type your information directly into the boxes below using your keyboard. When finished, click the gold button to "Save as PDF" and email it to us.
Option 2 (By Hand): Leave the boxes blank, click the gold button to "Print" the document, and fill it out with a pen to mail to us.

Brazil Spring Break

Thursday - Sunday, March 12 - 22, 2026

$4,843.00 per person (Double Occupancy)

Includes: R/trip Air from Houston, 4-5* Hotels, Breakfast & Dinners, Tours, Transfers & More

Primary Traveler Information

Name (Exactly as it appears on Passport)

Date of Birth

Passport Number

Passport Expiration Date

Street Address

City

State

Zip Code

Email Address

Contact Number (Cell)

Travel Mate Information

Travel Mate Name

Date of Birth

Passport Number

Passport Expiration Date

Street Address

City

State

Zip Code

Email Address

Contact Number (Cell)

Package Details

Package Selection

How Many Packages?

Payment Schedule

Payment Type	Due Date	Amount Due
Non-Refundable Deposit	June 15, 2025	$455.00
Installment 1	August 1, 2025	$900.00
Installment 2	October 1, 2025	$900.00
Installment 3	November 16, 2025	$900.00
Installment 4	December 20, 2025	$900.00
Final Balance	January 30, 2026	$788.00

Deposit Enclosed:

Check Zelle Money Order Visa/MC (Add 2.5%) AMEX (Add 3.5%)

Credit Card Number (If Applicable)

Expiration Date

Mailing & Contact Information

Make Checks Payable to: Heavenly Matched Travel Ministry

Mail to: P.O. Box 8182, Houston, Texas 77288

Contact: Ronald Ward | Phone: (713) 520-8005 | Fax: (713) 520-8095

Email: Heavenly-Matched@hotmail.com

Cancellation Policy & Terms

Late Fees: A $100.00 late fee applies for payments received after February 6, 2026.

Cancellations:
• Cancellations made inside 120 days of travel incur a 25% penalty.
• Cancellations made inside 60 days of travel incur a 50% penalty.
• Cancellations made after the final payment date (Jan 30, 2026) incur a 100% cancellation penalty.

*Heavenly Matched reserves the right to reschedule travel related to safety and/or weather-related conditions.

Traveler Signature

Date