Black & About Trip Registration Form

Black & About Trip Registration Form

Bali 2025
Traveler Details:
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
Emergency Contact for Trip*

First NameLast Name
Emergency Contact Phone Number*
Emergency Contact E-mail*
example@example.com
How did you hear about us?*
Please Specify*
Would you prefer to pay your deposit by Zelle or PayPal?*

ZellePayPal
Agreement to Terms and Conditions:*

I have read the Terms and Conditions associated with this trip prior to registering.
Refunds:*

I understand the refund terms and conditions should I cancel my trip for any reason.
Trip Insurance:*

I have been advised that I should purchase trip insurance to cover the costs of cancellation.
I certify that I am able to meet the physical specifications for this trip, which may require one or more of the following: walking long blocks, sometimes uphill or on uneven surfaces, up to a mile at a time, and climbing several flights of stairs without assistance.*

Yes, I am able to meet the physical requirements for this trip.
Should be Empty: