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TRIP APPLICATION

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________________________

_____________________________Time alone______________________________________________

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.