Photo Tour Trekkers :: Tour Registration

Title

Name

Known As

Home Address

City

Province/State

Postal Code/Zip

Home Phone

Cell Phone

Business Phone

Email Address

Confirm Email Address

Health Concerns?

Allergies?

Special Dietary Requirements?

Are you celebrating a special occasion & date?

If yes, please let us know the occasion & date.

As a traveller my experience is

Emergency Contact Name

Emergency Contact Phone

Airline Seat Preference

Single Room (single supplement will apply)

Request double share

Roommate Name (if blank we will assign)

Payment Option

Optional Hot Air Balloon Ride $475 US

Call me for credit card information

Frequent Flyer / Air Miles / Aeroplan Number

Pick up location

Date of Birth D-M-Y

Name as it appears on your passport

Passport Number

Passport Expiry Date D-M-Y

Nationality on Passport

Do you require cancellation insurance? *

Do you require medical insurance? *

I have read & agree with your Terms & Conditions. *

I agree to Trekkers & Tourcan's Privacy Policy. *

Trekkers Impressions Newsletter *

Share my email with other guests on this tour.

Travel Office Use

Indicate Use of Promotional Item

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