Galapagos 2018 Registration
Full Name (Please write it exactly as written in your Passport) *
It is important we have your exact passport name, as we will be buying flights on your behalf. If the name on the ticket does not match the name on your passport, the ticket may not be honored!
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Preferred name (or nickname)
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Month of Date of Birth *
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Day of Date of Birth *
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Year of Date of Birth *
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Home Address (please include street address; city; state; ZIP; country) *
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Best phone number to reach you *
Just in case we need to get ahold of you more quickly than via email!
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Email address *
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Passport country of issue *
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Passport number *
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Expiration date of passport (please see note below regarding expiration date) *
Please know that to enter Ecuador your passport must have at least six months validity and at least two blank pages
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Will you have a single room or a shared room on this trip? *
If you are willing to share but don't have a roommate already, we can let you know if others are in a similar situation. However, we can't guarantee that you will have a roommate.
If you have a roommate, do you prefer one big bed or two separate beds? (*Please note that hotels in Ecuador often have 2 big beds, regardless!)
If you are sharing a room, what is your roommate's name?
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Hobbies/Interests/Occupation; we'd love to know a little about you and this will also help us suggest activities and sites for you. *
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Emergency contact information *
Name; Relationship; Phone Number; Email
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Food allergies (gluten, dairy, etc) / Dietary restrictions (vegetarian, vegan, don't eat fish, etc).
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Any health conditions/allergies (food, drug, or environmental) we should be aware of? Are there any medications you will need refrigerated or medical devices that require electricity?
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I have read the Suggested Fitness Requirements section of the website. *
How comfortable are you swimming? Have you ever snorkeled before? *
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Are you comfortable walking short distances over rocks? (See example photo) *
Captionless Image
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What are you hoping to experience on this journey? How can we help you get the most out of your time with us? *
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Where did you hear about this trip? *
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Please read and sign the Tour Contract and Liability Waiver below
I agree to the Tour Contract and Liability Waiver *
Required
Please sign below with your digital signature which consists of your full name *
Example: John Q. Sample
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