Galapagos Adventure, Nov 27-Dec 7, 2021 Registration
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Full Name (Please write your name *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 valid.
Preferred name (or nickname)
Email address *
We communicate exclusively by email in preparation for this journey, so please make sure you give us your best email and then add us to your address book.
Home Address (please include street address; city; state; ZIP; country) *
Best phone number to reach you *
Just in case we need to get ahold of you more quickly than via email only in an emergency.
Date of Birth (month, date, and year format) *
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Passport country of issue *
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 beyond the end of the trip 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 connect you to other guests also looking for a roommate. 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 of preference.)
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If you are sharing a room, what is your roommate's name?
Hobbies/Interests/Occupation; we'd love to know a little about you and this will also help us suggest activities and sites for you. *
Emergency contact information *
Name; Relationship; Phone Number; Email. Please make sure your emergency contact is someone who is not joining you on this journey.
Food allergies (gluten, dairy, etc) / Dietary restrictions (vegetarian, vegan, don't eat fish, etc).
If any of this should change before the start of the trip, please let us know as soon as possible.
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?
I have read the Suggested Fitness Requirements section of the website. *
How comfortable are you swimming? Have you ever snorkeled before? *
Are you comfortable walking short distances over rocks? (See example photo)  Walking sticks are available for rent if needed (or you can bring your own). Please note that is only applicable for parts of 1-2 excursions; you can see other sample photos on your trip website under "Suggested fitness requirements." *
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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? *
I acknowledge that there may be specific COVID-19 protocols that must be adhered to, such as mask-wearing, hand-washing, and social distancing, in the spirit of keeping myself, fellow guests, and locals safe. Noncompliance with these measures will result in not being able to continue on the journey. *
Where did you hear about this trip? *
Please read and sign the Tour Contract and Liability Waiver below.  You can download a copy of this contract for your records at http://bit.ly/retreatourscontract2021
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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