Name 1 *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Gender

male

female

Phone (Home) *

(###)

###

####

Phone (cell) *

(###)

###

####

Phone (work)

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name 2

Only for couples living at the same address.

First Name

Last Name

Date of Birth

MM

DD

YYYY

Gender

male

female

Phone (home)

(###)

###

####

Phone (cell)

(###)

###

####

Phone (work)

(###)

###

####

Emergency Contact Name *

First Name

Last Name

Phone (home) *

(###)

###

####

Phone (cell)

(###)

###

####

Phone (work)

(###)

###

####

Roomate Arrangements *

I already have a roommate who has agreed to share a room with me. (e.g. spouse, relative, friend, etc.)

I would like a single room, if/when one is available, and am willing to pay the single occupancy fee.

I do not have a roommate, but would like to share a room with another member of the tour. I am aware that if no roommate is available, I will be charged the single occupancy fee.

I prefer a room with: *

1 Bed

2 Beds

Smoking *

I smoke

I do not smoke

Snoring *

I snore

I do not snore

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)? *

No

Yes

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

No