Passenger Registeration Form

X P E D I T I O N S 2 0 1 0
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

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 $100 extra. Please pay with two $50 dollar bills.

Certified "TLC LLC"
You may mail your payment to:
TLC
PO Box 12343
Chandler, Arizona 85248
480 855 6226