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.