Pre Trip Questionnaire

Booking Agent (*)

Group Leader (*)

Lodges of interest (*)

Client Type (*)

Gender(*)

Arrival Date to the lodge(*)

Departure Date from the lodge(*)

Personal Information

First Name(*) (as it appears on your passport):

Last Name(*) (as it appears on your passport):

Nick Name

Passport Number(*)

Country (*)

Date Issued

Expiration Date(*)

Birth Date (*)

Birth Place

Occupation

Note: Your passport must be valid for six months following the last day of your South American trip. If your passport expires before then, please renew it right away.

Contact Information

Phone(*)

Email(*)

Address(*)

City(*)

Country(*)

Zip Code(*)

Business Phone

Others

Do you have a medical condition / dietary restrictions ?

Do you have any allergies (food, drink, insects) ?

Do you have any other request or comments ?

Please indicate your favorite drink

Emergency Contact

Name(*):

Relationship:

Phone Day(*):

Phone Evening:

International Flights

Arrival Date:

Time:

Flight N:

Company:

Arrival Airport:

Departure Date:

Time:

Flight N:

Company:

Departure Airport:

Domestic Flights

Arrival Date:

Time:

Flight N:

Company:

Arrival Airport:

Departure Date:

Time:

Flight N:

Company:

Departure Airport:

*Please answer the above security question so we know we are being contacted by a real person.