Booking Form Sample

INSTRUCTIONS: Thank you for confirming your trip with us. Every participant must submit a completed and digitally signed Booking Form to finalize the booking. We need this information as soon as possible in order to reconfirm your reservations. A parent or guardian must digitally sign the form for any travelers under 18 years of age. ("Digitally signing" simply means that you type in your name with the same effect as signing it.) You should have your passport information available when you sit down to fill out the form. All sections are required. Please note that after hitting the submit button the form may take a minute or two to be processed. Please hit the submit button only once. You will see a confirmation page once the form has been processed. You will have the option to email yourself a copy of the completed form. If you have any questions about anything, please don�t hesitate to ask.

TRAVELER INFORMATION

	TRAVELER 1	TRAVELER 2
First Name
Last Name
Address		Same
City
State
Zip
Day Telephone
Evening Telephone
Cell Phone
Email
How did you hear about us?

PASSPORT INFORMATION

	TRAVELER 1	TRAVELER 2
Name (Exactly as it appears on your passport )
Birth Date (MM/DD/YYYY)
Passport Number
Nationality (Country of issue for passport)
Passport Issue Date (MM/DD/YYYY)
Passport Issue Location
Passport Expiration Date (MM/DD/YYYY)

Please note: Most countries require a passport to be valid 6 months past the travel dates. If you do not yet have a passport or if you are renewing your passport, please note this below and provide us with this information as soon as it is obtained.

I am currently securing a new passport or renewing my passport

ACCOMMODATIONS

Please indicate the names of any other travelers who will share a room with you:


I would like to have my own room

I prefer the following room accommodations

Matrimonial Bed Twin Beds Triple Beds

If there is anything else we should know about your rooming
preferences or arrangements, please indicate it here:

Please note: Rooming arrangements are subject to availability

ARRIVAL INFORMATION

Please select from the following regarding your arrival and departure information:

	I have made my own flight arrangements and have forwarded a copy of my itinerary to Vaya Adventures (best option is to forward the confirmation email you received from the carrier)
	I have not yet booked my flight arrangements, but will send Vaya Adventures a copy of my itinerary once I have done so.

If you have not already done so, please forward your flight itinerary
to info@vayaadventures.com

If you have arranged any extra hotel nights for yourself before or after
your trip, please list the hotel name & appropriate dates here:

DIET & MEDICAL INFORMATION

	TRAVELER 1	TRAVELER 2
Do you have any dietary restrictions or requirements? (If so, please list)
Do you have any current medical conditions, infirmities or disabilities that we should be aware of? (If so, please list)
Please list the names of any medications you are currently taking that we should be made aware of.
Weight (lbs)
Height (feet-inches)

In case of emergency, please contact:

Name:		Relationship:
Day Telephone:		Evening Telephone:

HELP SUPPORT LOCAL COMMUNITIES AND THE NATURAL ENVIRONMENT IN THE REGION YOU ARE VISITING

We are often asked by our travelers how they can effectively assist the local people and help protect the natural environment in the areas where we run our trips. We believe the most effective way to help is by giving money to well established organizations that run efficient, successful programs dedicated to these ends. The following organizations fit those criteria and we encourage you to support them. Vaya Adventures can facilitate your direct contribution to these organizations by adding your contribution to your invoice. We will forward your desired contribution amount to the organization on your behalf (you will receive a receipt reflecting your donation). Making a contribution is an effective way to support local communities and preserve the natural environment of these areas:

IGTOA - International Galapagos Tour Operators Association (recommended donation for Galapagos travelers, funds the Charles Darwin Foundation and other environmental organizations working to protect the environment of the islands, gives targeted grants to support efforts to protect the Galapagos; we are a Full Member of this organization)

Donation amount per traveler: $50 $100 Other: $

Promujer (recommended for all travelers, highly respected organization providing microcredit to women to help them improve their lives; operations in several Latin American countries, including Peru, Argentina and Bolivia; we will match all donations to this organization up to an annual total of $2500; all contributions are tax deductible):

Donation amount per traveler: $50 $100 Other: $

PAYMENT INFORMATION

Deposits can be paid by credit card or by check. If paying by credit card, please call us at (510) 548-8487 with your credit card information. If paying by check, please make your check out to Vaya Adventures and mail it to:

Vaya Adventures
1525 Shattuck Ave., Suite J
Berkeley, CA 94709

*Please note: Final payment on most trips is due 90 days prior to departure (some Galapagos cruises and other trips have earlier payment dates). Balances are payable by check.

Please click to review the Terms & Conditions and Release of Liability:

Terms & Conditions and Release of Liability

	I do not agree
	I agree
	By checking this response I acknowledge that I have read, understand and accept the Terms & Conditions and Release of Liability that accompany this Booking Form.

	TRAVELER 1	TRAVELER 2
Digital Signature
Date (MM/DD/YYYY)

A parent or legal guardian must digitally sign the form and accept the Terms & Conditions and Release of Liability for any children under 18 years of age. "Digitally signing� simply means that you type in your name with the same effect as writing your signature.

PLEASE READ THIS NOTE BEFORE CLICKING SUBMIT
Once you click on the Submit button below, it may take a minute or two for the system to process your booking. In order to submit the form properly, please click once on the submit button, and please do not close your browser, hit escape or attempt to re-submit the form until you see a �Thank You� page. Thank you for booking your trip with us!


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