PERU HUAYHUASH BOOKING FORM
Please complete and submit this form along with the trip deposit so we can process your booking. Before submitting the form below, make sure to click on PAY TRIP DEPOSIT to take you to the payment page. If you have any questions, please email us at equity@browngaltrekker.com.  Thanks.
Sign in to Google to save your progress. Learn more
What trip dates are you booking for? *
TRAVELER INFORMATION
Please provide your name. *
What is your address? *
What is your phone number? *
Please describe your recent hiking experience. Have you done high altitude trekking in the past? How often do you hike? What is your plan in terms of training for the trek?
What is your email address? *
ACCOMMODATION STYLE
Choose one.  Note that for single room, additional fees apply. *
Do you need hotel stay before or after the trip? Please specify the dates and if it's single or shared. If not, type NA. *
PASSPORT & VISA DETAILS
The set of information below maybe required to obtain visa and book the flights as part of your trip.  Also, please note a scanned copy of your passport is required.
What is your nationality? *
What is your passport number? *
Please provide your date of birth. *
What is your passport's date of issuance? *
MM
/
DD
/
YYYY
What is your passport's expiration date? *
MM
/
DD
/
YYYY
Any dietary requirements? *
EMERGENCY CONTACT INFORMATION
Name: *
Email address: *
Phone Number: *
Any medical condition? *
Do you have a promo code? Enter it below.
Additional comments?
TERMS & CONDITIONS / WAIVER OF LIABILITY
Please make sure you read in full the terms and conditions and waiver of liability before booking.  You can read the documents via
https://www.browngaltrekker.com/tour-terms-conditions
https://www.browngaltrekker.com/tourliabilitywaiver
Did you review and thereby accept the terms and conditions as well as the waiver of liability?  Please type YES below.  Note: In addition, we will send you the forms to sign via email upon confirmation of your booking. *
Unti NOTE - Your booking is not confirmed until we receive the trip deposit along with the booking form. Before submitting the form, click on the following link to send your trip deposit: PAY TRIP DEPOSIT. Send both to secure your spot for the trip. 
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms