Private Tour Registration Form

Tour Start Date

YYYY

Participant Information

Name

First Name

Last Name

Date of Birth

YYYY

Gender

male

female

Phone (Home)

Country

(###)

###

####

Phone (Cell)

Country

(###)

###

####

Email Address

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact

Emergency Contact Name

First Name

Last Name

Relationship

Phone (Home)

Country

(###)

###

####

Phone (Cell)

Country

(###)

###

####

Phone (Work)

Country

(###)

###

####

Health Information

Do you have any disability or illness that might affect or restrict your full involvement in any aspect of the tour, or of which we should be aware for your safety (e.g., walking difficulties, diabetes, asthma, anigma)?

Yes

If you answered yes to the previous question, please provide details here.

Please list any prescriptions and medications (including dosages) that you will be taking during the tour.

Please list any allergies (medical, food, or environment).

Please list any dietary restrictions or requirements, or other types of special requirements, so that we can do our best to accommodate you.

Additional Comments

Please provide any additional information or questions.

Important: Terms and Conditions

I have read the Tour Details and Policies at www.newenglandbirdtours.com/tour-details-policy/ including information about payments, refunds, and cancellations. I understand this material and agree to its terms and conditions.

Yes