Registration Form -- Pan de Vida Travel -- Formulario de Registro

Use this form to register for this tour. Please register your legal name as it appears on your passport. Learn about our referral program after you register. Have a visible copy of your passport and a photo of yourself available to upload to this form.
1. First Traveler Info

* Note (Mandatory field)
Full Name *

First Name Last Name
Gender *
Please select
Age *
Date of Birth *

Month DayYear
E-mail*
ie: john@gmail.com
Address*

Street Address

Street Addreess 2

CityState

ZIP Code
Country*
Cell Phone *
Please: add international country access code number
Passport Number *
Passport Country*
Country of residence
Place of Birth *
City and Country
Rooming With... *
Input full names if possible
VegetarianVeganRegular Meals
Religious Affiliation
YesNo
If not, when was your last visit there?
Emergency Contact Info*

First Name Last Name
Emergency Contact Phone*
Phone number
Emergency Contact Email*
ie: john@gmail.com
Allergies
State which
Health conditions or Medication
Please state all medical conditions or health issues. Also write down which meds you are taking.
2. Second Traveler Info

* Note: If there is a 2nd Traveller, please complete ALL fields.
Full Name

First Name Last Name
Gender
Please select
Age
Date of Birth

Month DayYear
E-mail
ie: john@gmail.com
Address

Street Address

Street Addreess 2

CityState

ZIP Code
Country
Cell Phone
Please: add international country access code number
Passport Number
Passport Country
Country of residence
Place of Birth
City and Country /
Rooming With...
Input full names if possible
VegetarianVeganRegular Meals
Religious Affiliation
YesNo
If not, when was your last visit there?
Emergency Contact Info

First Name Last Name
Emergency Contact Phone
Phone number
Emergency Contact Email
ie: john@gmail.com
Allergies
State which
Health conditions or Medication
Please state all medical conditions or health issues. Also write down which meds you are taking.
Relationship with First Traveller
Tour Package Options

Make your travel choices below (required). All funds are denominated in US$. Conversion will be done at time of payment processing and will reflect any prevailing fx rate.
Main Tour - $3799/person. (Including airfares from Chicago, LA or NY up to $500 or alternate a credit of $500 of departing from a different city)Pre-Extension to the Amalfi Cost - $999/person (minimum 6 people)Post-Extension to London - $999/person (minimum 6 people)Post-Extension airfare - $150/personInsurance (highly recommended) - $100/personAirport pick up - $40/personAirport drop-off - $40/personSingle room Supplement Main tour $850/personSingle room Supplement Pre-Extension - $300/personSingle room Supplement Post-Extension - $300/personTips Main Tour - $60/person***Tips Pre-Extension - $30/person***Tips Post-Extension - $30/person***Extra and optional excursion - Vatican Museum and Sixtine Chapel - $150/personExtra and optional excursion: Annecy Boat (1hr) - $30/person
*Fare is based on economy class seats and is per person. Ask for other departure cities. Pricing paid by customer does not necessarily reflect Pan de Vida Pricing.

*** For bus drivers, guides, bonus locations
Traveler Choices

Please check all boxes that apply:
If not rooming with a family member, I wish to room with the person(s) listed above.Please match me up with another single going on the trip for $50 administration fee (if no other single is available, Iunderstand I am subject to the single room surcharge) Ask about triple occupancy.I wish to have a room all to myself (single room surcharge of $850 main tour)I understand that I should arrive in Rome and leave from Prague if doing main tour.I am in good health. I understand that the Tour will require walking, with lots of standing while sightseeing. I also realize I will have to carry my own bags - sometimes up stairs. (Those suffering any chronic diseases should consult a physician to gain clearance).I understand that I will be responsible for the care of the audio transmitter and earphone issued me. In case of damage or loss of the transmitter I understand that I will pay for repair or $135 for a replacement.I decline the offer to purchase insurance. I understand that I am solely responsible for any delays, cancellation penalties, sickness, accidents and out-of-pocket expenses incurred. This waiver confirms that I voluntarily decline travel insurance for this tour. I understand I am solely liable and I hereby release Pan de Vida Travel and their agents from any and all liability associated with my failure to purchase travel insurance. I made the choice to decline insurance coverage (NOTE: Some destinations may require proof of Travel Protection Insurance, so if you decline our insurance, we strongly recommend that you get your own. We are not responsible if you are denied entrance due to lack of insurance).I accept to pay $100 travel insurance per person. That includes trip cancellation due to weather or mechanical malfunction, personal property and medical benefit. (Insurance available up to age 79. Ask for details if 80 and older).I allow Pan de Vida to use my credit card to pay extra expenses that may depend on me.I have read the terms and conditions of the tour. Please enroll me now.
Paying for This Trip

You can send your payments to the Conference or send them directly to Pan de Vida Travel: ZELLE: Juan Suarez 914-804-5699----------------------------------------------------------CASH-APP: Juan Suarez - $mropportunities7----------------------------------------------VENMO: @Johnny-Suarez-3----------
Hotel Bedding
Upload a copy of your current Passport here. (If you are renewing your passport, you can send it to us later).

.jpeg, .png, .gif file types accepted
Cancelof
I acknowledge that I have read this registration form completely, and the information I provided is accurate. I will supply, when requested, my payment information to facilitate payment of the minimum $350/person deposit and any other amounts needed to secure this trip. I understand that my deposit is non-refundable and other cancellation penalties will apply depending on the cancel date. I understand that if my roommate (s) cancel, my rate will change. I understand that all monies must be paid by the final payment date. If my balance is left unpaid, my cabin will be canceled immediately. Prices for reinstated cabins may be higher than initial rate and a $50 reinstatement / administration fee will be charge by Pan de Vida Travel regardless of the cancellation date.
Do you agree to the terms and conditions*
Your booking is not complete until you click the [Submit Registration] button. Questions? +1 248 275 1050
Should be Empty:

Use this form to register for this tour. Please register your legal name as it appears on your passport. Learn about our referral program after you register. Have a visible copy of your passport and a photo of yourself available to upload to this form.

1. First Traveler Info

2. Second Traveler Info

Tour Package Options

Traveler Choices

Paying for This Trip

Your booking is not complete until you click the [Submit Registration] button. Questions? +1 248 275 1050