Personal details for travel with groups in Peru

Welcome to Peru!

Before we can book your accommodation for each stage of the journey and any Peruvian train tickets we need to know a few of your details.

Please fill in the form below as fully as possible and click send to send it to me, Joe. Your details will only be kept by us until after the journey or group finishes. So if you come on a future journey with us you will need to send them again.

We appreciate the you may not know some details yet, such as health and travel insurance, but these can be forwarded later. For now we need to know at least your personal details and passport details so that we can make your reservation.

Many thanks for your help

Joe

About you:

First name

Last name

Your Phone number

Your Email Address

Your home address

Home Address

Date of birth

About your Passport:

Passport number

What is your Nationality?

Where was your passport issued?

When was your passport issued?

Issue date

When does your passport expire?

Expiry date

It is a requirement of this group journey that you have adequate personal travel and health insurance

Personal Travel Insurance details including policy number, policy provider and their contact details

In case of an emergency who can we contact for you?

Emergency contact name

Your relationship to them. Husband/Wife, Son/Daughter, Parent, friend etc.

Husband/Wife Son/Daughter etc

Emergency Contact Phone number

Emergency Contact email address

Anything else you need us to know

I confirm that I take full responsibility for my health, well-being and my safety during this trip

(tick box to confirm)

Human Verification

Joe Molloy Shaman ~ Shamanic Healing of the Incas

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