JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Peru Gypsy Tour Registration
Light of Lemuria
Mermaid Waters, QLD
Australia
Ph: 0405305786
Email:
trisha@lightoflemuria.com.au
Web:
www.lightoflemuria.com.au
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Title
*
Choose
Mrs
Mr
Miss
First Name
*
Your answer
Last Name
*
Your answer
Date Of Birth
*
MM
/
DD
/
YYYY
Passport Number
*
Your answer
Passport Expiration Date
*
Your answer
Country of Passport
*
Your answer
Will you need help with flights and a visa?
*
Yes
No
Maybe
It is compulsory to get travel insurance. Would you like us to help you with this?
*
Yes
No
Maybe
Street Address
*
Your answer
City
*
Your answer
State/Province
*
Your answer
Zip Code/Postal Code
*
Your answer
Country of Residence
*
Your answer
Phone Number
*
Your answer
Emergency Contact Information: Please list your emergency contact's name, address, country, phone number(s) and email address
*
Your answer
Room Request
*
Choose
Single Room
Twin Share
If you are traveling with a companion and want to be paired in the same room, please enter their name here
Your answer
Please list any special dietary or health requirements you have
*
Your answer
Departure City
*
Your answer
What Tour were you interested in?
*
Your answer
Dietary restrictions
*
None
Vegetarian
Vegan
Gluten-free
Other:
Have you been on a spiritual Tour before?
*
Yes
No
Required
As this is a spiritual Tour and not a normal tourist style trip, what are you hoping to get out of this experience?
*
Your answer
what is your ideal way to travel?
*
Adventure style
Luxury style
backpacker style
comfort & safety
not fussed
spiritual travel
relaxing & slow paced
filled with lots of activities
Required
Are you physically fit for this tour? Any health concerns?
*
Your answer
Are you mentally fit for this tour? Any mental illness?
*
Your answer
What are your main reasons for wanting to do this spiritual tour?
*
Your answer
As this is a spiritual tour, we need to know if you are the type of person who can go with the flow? Or you do not like much change?
*
Your answer
Are you able to enjoy group dynamics and follow a set itinerary?
*
Your answer
If you get accepted, will you be ready to commit to paying your deposit?
*
yes
No
Required
By clicking yes, you are agreeing and have read the legal terms and conditions including the privacy policy.
*
Yes I agree and I have read the terms and conditions/ privacy policy
Required
Terms and Conditions/ Privacy Policy
A copy of your responses will be emailed to the address you provided.
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms