Belo USA

Choose your trip(s) *
Select one or more trips that you wish to register for.
East Coast Trip

June 16 to June 29 - $2930.00
Please choose accommodations:

Standard Accommodation (2 students per bed, 4 to a room) - Included

Single Bed Accommodation (Own bed for an extra fee) - Add $1250.00
Hawaii Expedition

March 16 to March 22 - $1985.00
(Full - Waiting List Available)
Please choose accommodations:

Standard Accommodation (2 students per bed, 4 to a room) - Included

Single Bed Accommodation (Own bed for an extra fee) - Add $495.00
New York City

March 29 to April 2 - $1280.00
Please choose accommodations:

Standard Accommodation (2 students per bed, 4 to a room) - Included

Single Bed Accommodation (Own bed for an extra fee) - Add $495.00
New York City/Washington DC

March 29 to April 5 - $1750.00
Please choose accommodations:

Standard Accommodation (2 students per bed, 4 to a room) - Included

Single Bed Accommodation (Own bed for an extra fee) - Add $695.00
West Coast Trip

June 10 to June 23 - $2950.00
Please choose accommodations:

Standard Accommodation (2 students per bed, 4 to a room) - Included

Single Bed Accommodation (Own bed for an extra fee) - Add $1250.00
Participant Details
You are: * First Name *Last Name *Nickname (name you like to be called) Country of Origin *Passport Country *Passport Number * E-mail Address *Cell Phone No (with Country Code)Select Date of Birth *Gender *What is the full name of your US Rotary Club Youth Exchange Officer (YEO) and your district number? *Please provide the phone number and email address of your US YEO. * InstagramFacebookWhatsApp Exchange Year: *
Host Country Information
First Name of Host Parent #1 *Last Name of Host Parent #1 *Cell Phone No (with Country Code) E-mail Address *First Name of Host Parent #2Last Name of Host Parent #2Cell Phone No (with Country Code) E-mail AddressStreet Address *City *State/Province *Zip/Postal Code *Country *Host Family Home PhoneHost High School Name * Host High School City and State/Province *
Home Country Information
First Name of Natural Parent #1 *Last Name of Natural Parent #1 *Cell Phone No (with Country Code) E-mail Address *First Name of Natural Parent #2Last Name of Natural Parent #2Cell Phone No (with Country Code) E-mail AddressStreet Address *City *State/Province *Zip/Postal CodeCountry * Home Phone NoHome School Name *Home School City *Home (Sponsor) Organization *Home (Sponsor) District/Division
Medical Information
Name of Medical Insurance Company *Insurance Policy No. & ID No. *Allergies, if any *Medications, if any *Dietary Restrictions, if any *I have received my Covid-19 vaccine or I plan on receiving it at least 45 days before my first trip. * Yes No
General Information

Do you smoke? * Yes NoCan you swim? * Yes NoHave you had swimming lessons? * Yes NoT-shirt Size: * How did you hear about Rotary 5400 Tours with Belo USA Travel? * * I have read and I do agree with all of the terms of this trip's general conditions.
* I agree that my personal information may be used in accordance with our privacy policy.

* This information is required.

Reservation Form

Rotary 5400

Reservation Information