[1004-1014 Breathe Korea 1 2026] Application Form

Program Group Assignment Notice
For programs including massages, rickshaw tours, seal-making, and K-Medi Center activities, participants may be divided into groups due to space limitations

Last Name

First Name

Middle Name

Gender

Citizenship

Passport Issuing Country

Passport Number

Passport Document Number

Passport Expiration Date

Formate DDMMMYY Ex) December 7, 2035 ⇒ 07DEC35

Room Type

TWN: 2 Twin Beds for 2 Guests
SGL: 1 Single Bed for 1 Guest
TPL: 2 Twin Beds + 1 Single Bed for 3 Guests

E-mail

E-Mail Address

Phone Number

Home Address

Mileage Airlines

Select your airline for mileage accrual

Mileage Number

Known Traveler Number

Global Entry or TSA Number

Emergency Contact Name

EMERGENCY CONTACT INFORMATION

Emergency Contact Relation

EMERGENCY CONTACT INFORMATION

Emergency Contact Number

EMERGENCY CONTACT INFORMATION

Emergency Contact Email

EMERGENCY CONTACT INFORMATION

Food Allergy

If yes, please specify your food allergies

severity of allergy, symptoms, contact sensitivity, etc.

Medical Info

Please list any medical conditions or concerns that may affect your participation in this tour.

Tour Package Type

Full Package: Round Trip Air + Land Package
Land Package: Land Package Only (No Air)

Returning Guest?

If you have previously joined our fully escorted fixed date tour, please select YES.

Returning guests are eligible for a Special Discount, so please be sure to ask our staff.

Additional Requests

If you have previously joined our fully escorted fixed date tour, please select YES.

Returning guests are eligible for Special Discounts, so please be sure to ask our staff.

Name Phone Contact

If 'Other', please specify: