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.

New York 5-Day Getaway

Tuesday - Saturday, May 26 - 30, 2026

$1,893.00 per person (Double Occupancy)

"Joe Turner's Come & Gone" Featuring: Taraji P. Henson and Cedric the Entertainer

Primary Traveler Information

Name on Driver License / Passport

Date of Birth

Street Address

City

State

Zip Code

Email Address

Contact Number

Travel Mate Information

Travel Mate Name

Date of Birth

Contact Number

Street Address

City

State

Zip Code

Package & Payment Details

Package Selection

How Many Packages?

Payment Schedule

Payment Type	Due Date	Amount Due
Non-Refundable Deposit	December 6, 2025	$400.00
Installment 1	January 20, 2026	$500.00
Installment 2	March 3, 2026	$500.00
Final Balance	April 19, 2026	$493.00

Deposit Enclosed:

Check Zelle Money Order Visa/MC (Add 3.5%) 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 the final payment date (April 19, 2026).

Cancellations:
• Cancellations made inside 60 days of travel incur a 50% penalty.
• Cancellations made after the final payment date incur a 100% cancellation penalty.

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

Traveler Signature

Date