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X P E D I T I O N S   2 0 0 8
R E G I S T R A T I O N   •   F O R M

 

Registration Form (one per person) : Complete and click "Submit" once finished
Your Full Name:
Your E-Mail:

Your Passport Number :

Your Age:

Your Birthday:


Which trip(s) is this for?
Your Home Phone Number:
Your Cell Phone Number:
Place your complete address here:


E M E R G E N C Y    C O N T A C T    I N F O
Contacts Name:
Street Address :
City, State, Postal Code :
Country:
Best Contact Phone Number :
Best Contact Cell Phone Number:
Relationship To You :

 

 
A C C O M M O D A T I O N     P R E F E R E N C E
Single or Double?   Single       Double
Would you like us to arrange a roommate if possible?   Yes       No
 
M E D I C A L
Please explain below if you are currently under a doctors care or need special care:

 

 
Have you purchased Travel Insurance?   Yes       No
If not, do you intend to?   Yes       No  (This is highly suggested. You must purchase travel insurance within 15 days of your deposit)
 
Is there something special you are hoping to see or do?

 

 
E L E C T R O N I C    S I G N A T U R E

With your electronic signature you assure us you have read and completely understood the "Tour Information" section and the" Terms and Conditions" section, and you completely agree.

We will not accept anyone who has not completely filled out, signed and submitted this application.

An electronically signed application and your deposit must be received to secure your space on this trip.

You are responsible to have a valid passport that does not expire within the next 6 months!

 

 

 

 

 

                  Sign Here (type your name): 

 

IMPORTANT: Please email us a current photo of yourself: Xpeditions@Mac.com

 

 

  • You can now make your payment online! All currencies, credit cards and checks can be processed and your trip paid for in just a few minutes.
  • Trip begins and ends in Lima, Peru
  • No international fares are provided
  • All prices are quoted as per person, double occupancy based on a minimum of 10 passengers
  • Tips and airport taxes are $85 extra per trip option

Certified checks must be made payable to: "Jerry or Kathy Wills"
You may mail your payment to:
Jerry Wills
9163 W. Union Hills Drive #105-5
Peoria, AZ 85382
 602 604 0212