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Rhine Castles & Swiss Alps River Cruise
Elegant Sicily
SANDALS® GRANDE ST LUCIA
SANDALS® ROYAL CURAÇAO
Galapagos Islands Cruise
HYATT® ZIVA™ AND ZILARA™ CAP CANA
Argentina & Patagonia Cruise
THE BEST OF ITALY
African Safari Seminar

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Trip Registration

Trip Registration

Selected Trip*
Name*
Salutation Legal First Name(s) as per passport Legal Middle Name(s) as per passport Last Name(s) as per passport
First Name commonly used
Gender*
- Female
- Male
- Prefer not to answer
Date of Birth*
MM
DD
YYYY
Passport Number*
Passport Country*
Passport Issue*
MM
DD
YYYY
Passport Expiration*
MM
DD
YYYY
Mobile or Primary phone*
Secondary Phone*
Primary Email*
Secondary Email*
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Dietary requirements and allergies
Emergency Contact Name*
Emergency Contact Relationship*
Emergency Contact Phone Number*
Total number of adults in the room/cabin*
Please enter a value between 1 and 4.
Total number of children in the room/cabin (12 and under)
Please enter a value between 1 and 4.
Enter ages of all children
Cabin type or category requested
Number of beds required*
- one bed (queen/king)
- two beds (twin/double)
Cruise line preferred dining (if applicable)
- Early Dining
- Late Dining
- Flexible/Select Dining
Prefer to dine with (friends/family) also travelling in the group:
Tourcan Vacations can assist with flights, transfers, and pre/post KPES travel arrangements. Tourcan Vacations is unable to assist with Aeroplan reservations. Would you like Tourcan Vacations to quote/book any of these additional travel components?*
- Yes
- No
Special requests (ie wheelchair assistance, airline meals or preferred seating)
Kennedy Professional Educational Seminars and Tourcan Vacations strongly recommends purchasing travel insurance to protect you against many unforeseeable circumstances. We recommend our travel specialist contact you to provide details.*
- Yes, Please contact me
- No, Do not contact me
“I’ve read and acknowledge the importance of speaking to a travel insurance specialist so I’m fully aware of all my insurance options and coverages. Although travel insurance can be purchased elsewhere, it’s important to fully understand the terms of each insurance policy as they differ vastly.*
- I have purchased Travel Insurance elsewhere
- I am declining Travel Insurance and will complete the below waiver to be sent to Tourcan Vacations
Download & complete this Waiver, then Email to Tourcan.
Dental/Medical Practice Name*
Seminar Registration Type*
Type of Practice/Specialty*
- General Practitioner
- Oral Surgery
- Periodontist
- Prosthodontist
- Endodontist
- Orthodontist
- Restorative
- Medical professional
- Other
- Not Applicable
Other
Have you travelled with Kennedy Professional Educational Seminars in the past?*
- Yes (1-2 times)
- Yes (3-5 times)
- Yes (6+ times)
- No, This is my first KPES seminar
How did you hear about this trip and seminar?*
- Kennedy Seminars website
- Oral Health advertisement
- American Dental Association advertisement
- Dr. Jack Lipkin or Dr. Marshall Hoffer
- Dental Colleague
- Tourcan Vacations Travel Advisor
Would you like to be added to the Kennedy Seminars email list to be notified of future dental seminars and trips?*
- Yes, please add me to your email and mailing list
- No, I do not want to receive future email or mail marketing
Terms and Conditions
Please review payment amounts, cancellation dates and penalties, full terms and conditions here:
Kennedy Seminars

Tourcan Vacations
(Terms and Condition links open in a new window)
Terms and conditions agreement*
- I have reviewed and agree with the terms and conditions on the Kennedy Seminars and Tourcan Vacations websites.
Are you bringing a Guest?*
- Yes
- No
Additional Guest
Name*
Salutation Legal First Name(s) as per passport Legal Middle Name(s) as per passport Last Name(s) as per passport
Guest Relationship*
Registration Type*
Gender*
Date of Birth*
MM
DD
YYYY
Passport Number*
Passport Country*
Passport Issue Date*
MM
DD
YYYY
Passport Expiration*
MM
DD
YYYY
Mobile or Primary Phone Number (if different than first guest)*
Primary Email Address (if different than first guest)*
Dietary requirements and allergies
Phone
This field is for validation purposes and should be left unchanged.

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