Registration and Payment 2

Traveler Information

Rest assured that your information is secure. We use the same level of protection as major financial institutions.
Name*

First NameLast Name
Email*
example@example.com
Destination*
Phone Number*

Area CodePhone Number
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have your passport handy? No problem if not, we'll follow up later.

Yes!
Passport Number
Passport Nationality
Passport Expiration

MonthDayYear
Passport must be valid at least 6 months past trip completion date.
Liability Waiver*
Add a second traveler?

Yes!No
Second Traveler
Name

First NameLast Name
Email
example@example.com
Date of Birth

MonthDayYear
Date
Passport Number
Passport Nationality
Passport Expiration

MonthDayYear
Passport must be valid at least 6 months past trip completion date.
Liability Waiver*
Add a third traveler?

Yes!No
Third Traveler
Name

First NameLast Name
Email
example@example.com
Date of Birth

MonthDayYear
Date
Passport Number
Passport Nationality
Passport Expiration

MonthDayYear
Passport must be valid at least 6 months past trip completion date.
Add a fourth traveler?

Yes!No
Fourth Traveler
Name

First NameLast Name
Email
example@example.com
Date

MonthDayYear
Date
Passport Number
Passport Nationality
Passport Expiration

MonthDayYear
Passport must be valid at least 6 months past trip completion date.
Liability Waiver*
Add a fifth traveler?

Yes!No
Fifth Traveler
Name

First NameLast Name
Email
example@example.com
Date of Birth

MonthDayYear
Date
Passport Number
Passport Nationality
Passport Expiration

MonthDayYear
Passport must be valid at least 6 months past trip completion date.
Liability Waiver*

Additional Information
Emergency Contact*

First NameLast Name
Emergency Contact Phone*

Area CodePhone Number
Any dietary restrictions, health concerns, or other notes our guides should be aware of?**
Other Travel Details

Are you interested in the optional extension to the beautiful beaches of Santa Teresa?
YesNo
If you are a solo traveler, there are a limited number of rooms with two twin beds available. Are you open to sharing a queen bed with a traveler of the same sex?
YesNo
We have one room available with 3 twin beds. It is a larger room ensuring you will have plenty of space. Are you open to the larger room?
YesNo
Travel Insurance
We highly recommend travel insurance upon booking your trip, as unforeseen events can affect even the best-laid travel plans. Our travel insurance plans cover trip cancellation, missed connections and itinerary changes, baggage issues, emergency medical and other issues, and more. We offer travel insurance plans to fit every budget. If you decline to purchase travel insurance, please ensure that you have adequate international medical coverage.
Would you like to receive a travel insurance quote for your trip?*

Yes, please send me a quote for travel insurance.No, I do not want any information regarding travel insurance.

Booking Terms and Conditions*
Sign here to confirm all information above is complete and accurate to the best of your knowledge.*

Clear

PRICE: $1995 PER PERSON
BASED ON DOUBLE ACCOMMODATIONS

Deposit: 30% ($600) due today
Final Balance: Due Feb 24, 2019

Payment Info

USD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

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Traveler Information