Pulse of Rishikesh 2019 Registration
Full Name (Please write it *exactly* as written in your Passport, including middle name, if applicable) *
Your answer
Preferred name (or nickname)
Your answer
Date of Birth *
Please make sure you are using Month - Day - Year format
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Home Address (please include full street address; city; state; ZIP; and country) *
Your answer
Best phone number to reach you *
Just in case we need to get ahold of you more quickly than via email in an emergency.
Your answer
Email address *
We reply SOLELY on email to communicate details of the trip, so please add our email addresses to your address book when you receive emails from us.
Your answer
Passport country of issue *
Your answer
Passport number *
Your answer
Expiration date of passport *
Important note: Your passport must have at least six months validity from the end of the trip and at least two blank pages in it. Please make sure you're using Month - Date - Year format.
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DD
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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 are sharing a room, what is your roommate's name?
Your answer
Occupation & Interests: Please tell us more about you so we can make sure you get the most out of your time with us! We can help find little gems along the way that are in line with your interests. *
Your answer
Emergency contact information *
Please include this person's Name; your relationship to them; their Phone Number and their email address.
Your answer
Food allergies (gluten, dairy, etc) / Dietary restrictions (vegetarian, vegan, etc)
Your answer
Please check this box to acknowledge that you are aware that Rishikesh is a vegetarian, alcohol-free town and you agree to abide by these guidelines. *
Required
Do you have any health conditions and/or severe allergies (food, drug, or environmental) we should be aware of? Do you use any medications you will need refrigerated or medical devices that require electricity?
Your answer
I am able to walk at least 1/2 mile distance unassisted and without stopping. *
This is a general physical guideline for this trip. You are never obligated to participate in any activities, but you should know that some day excursion will require this amount of walking or more. Your trip leaders will inform you about any extra physical requirements for each excursion.
Required
I am aware the travel insurance which covers emergency medical care, emergency evacuation, and repatriation is required for this journey, and I will provide proof of coverage before the trip. *
Required
What are you hoping to experience on this journey? How can we help you get the most out of your time in Rishikesh? *
Your answer
How did you first learn about this trip? *
Your answer
Please read and sign the Tour Contract and Liability Waiver below (You can access and download a copy for your records at this link: https://goo.gl/EoCwk6 )
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
Your answer
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