RESERVATION FORM
Please fill one form per person
TRIP SELECTION :
Name of the trip :
Code of the trip :
Select your activity :
Sea kayaking
Trekking
Horseback riding
Rafting
Mountaineering
Patagonia cruises
Fly fishing
Deluxe adventure
Multiactivities
Culture trips
Expeditionary cruises
Highligh crossings
Skiing
Arriving date :
Flight of arrival :
Return date :
Flight of departure :
Starting on the :
Trip lenght :
Number of your Party:
IDENTITY :
First Name:
Family Name(s) :
Address:
City:
Zip Code:
State:
Country.
*E-mail:
Phone:
Fax:
Occupation :
Office phone:
PERSONAL INFORMATION:
Date of birth :
Sex :
man
woman
Nationality:
Marital Status:
Weight :
Height :
Passport number :
Expiration date :
EMERGENCY CONTACT INFORMATION :
Name :
Relationship :
Daytime phone :
Evening phone :
ACCOMMODATION :
Number of Travelers
:
Shared room :
Name of person who want to share the room with (if known) :
Single room* :
*Note that participants that occupy single room must pay a supplement fee.
DIETARY REQUIREMENTS :
State any health condition that may affect you as a traveler :
How did you first learn of Altue Active Travel ?
travel book
travel site
Internet research
friends, relatives
other
Specify :
Have you ever traveled with Altue active Travel before ?
Yes
No