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Living Morocco, 36 West 89th Street, New York, NY 10024 212.877.1417
Important: Please print or type all information requested as completely as you can (helpful in putting together groups) for each participant (photocopy form as needed), sign, and return accompanied with the signed Release of Liability & Acknowledgment of Risk form, and $500 deposit for each person. If less than 90 days, it's $950 per person.
Name of Trip__________________________________________ Date of departure________________
Your Name (exactly as it appears on your passport)_____________________________________________
Mailing Address_________________________________City ________________________State______
Zip Code_________Home Phone ( )______________(best hours to reach)Mobile ( )_______________
Work Phone ( )____________(best hours to reach) Fax ( )_____________Email__________________
Passport #______________________Place of Issue__________________Date of Expiration____________
Birthdate (month/day/year)_____________Citizenship_________________Marital Status___________
M__F__Age_____Height_____Weight_____Which physical activities you regularly do? how often?
aerobics (which)________________________________stretching (which)________________________
strengthening (which)____________________Yoga__________Tai Chi________Other______________
Describe your health (any problems we should know about)_______________________________________
Current medications/dosage _____________________________Primary MD/Phone__________________
Describe your work & identify your title_____________________________________________________
Interests outside work that occupy your time: which ones involve group activity________________________
Places traveled outside US that are favorites? when? why?______________________________________
Gone with adventure travel groups before? where? when?________________________________________
Which company___________Your experiences________________________________________________
Describe your ideal trip__________________________________________________________________
Your preference: ____double bed ___2 twin beds ____single room at a supplement ____share a twin room
Dietary restrictions & allergies ___________________________________ ____Non-Smoker ____Smoker*
*smoking is permitted only out-of-doors, away from non-smokers
How did you find out about Living Morocco? ___internet __friend __article __ad __________other, name
In case of emergency, notify: Name_____________________________Day Phone ( )_______________
Eve /cellPhone ( )___________Address______________________________Relation_____________
Living Morocco will help you make international & intra-country flight reservations according to trip itinerary. If you'd like to depart earlier or extend your stay, let us know.
Would like to purchase Travel Insurance from Living Morocco____will purchase your own____decline to purchase insurance even though Living Morocco strongly recommends it____.
Do not forget to mail: your deposit, check payable to Living Morocco, your signed Release of Liability/Acknowledgment of Risk form along with this completed form for each registered person.