INCAS DEL PERU, Reservation Booking Form

Personal Information

Name :

First Name

Surname

Passport No:

Place & Date of Issue

Expiry Date

Address:

St./Av.

Number

City

Country

Telephone Number :

Home

Work

Fax Number :

Home

Work

E-mail Address :

Birthdate

Sex

Marital Status

Ocupation

Nationality

Any Medical condition / history or disability
we should be aware of ?

Name and address of a person to contact
in case of an emergency :

About Incas del Peru

Please tell us how you know about Incas del Peru ?
Ad in newspaper / magazine / other ?

About the Program/Trip

	.
Total Number of Weeks	Total Number of Days

Start Day:	End Day:
	.

Program Cost

	.
Booking Fee :
Which Program? :
Airport Pick-up (Yes/No) :
Other/Extras :
Aplying for Discount? Which One? :
	.

Host Family Request

	.
Children (Yes/No) :
Smokers (Yes/No) :
Special Dietary Needs (Yes/No) :
Others :

For our trips all members are placed in double tents, or in shared rooms at hotels, additional costs will aply for those who require single accomodation.