Exotic Birding Information Form

PARTICIPANT INFORMATION

Participant Name: __________________________________________________________________________

Emergency Contact Name(s), Relationship, and Phone Numbers:

__________________________________________________________________________________________

__________________________________________________________________________________________

Pertinent Medical Information We Should Know About:

__________________________________________________________________________________________

__________________________________________________________________________________________

Do you have any disabilities or illness that might restrict full participation in any aspect of the tour? _______

If yes, please describe: ______________________________________________________________________

__________________________________________________________________________________________

Please describe any dietary restrictions or other special requirements you may have and we'll do our best to
accommodate them:

__________________________________________________________________________________________

PASSPORT INFORMATION

Participant

Name as it Appears on Passport: ______________________________________________________________

Nationality & Passport Number: ______________________________________________________________

Occupation (Former if Retired): ______________________________ Passport Expiration Date: __________

Place of Issue: _____________________________________________ Date of Issue: ___________________

Place of Birth: _____________________________________________ Date of Birth: ___________________

Additional Participant or Companion

Name as it Appears on Passport: ______________________________________________________________

Nationality & Passport Number: ______________________________________________________________

Occupation (Former if Retired): _____________________________ Passport Expiration Date: ___________

Place of Issue: ___________________________________________ Date of Issue: _____________________

Place of Birth: ___________________________________________ Date of Birth: _____________________

FLIGHT INFORMATION

Scheduled Arrival at Start of Tour:     Airline/Flight #: ___________________ Date/Time ________________

Scheduled Departure at End of Tour: Airline/Flight #: ___________________ Date/Time ________________

OTHER INFORMATION (e.g. Non-birding Activities Desired During Tour, Special Requests, etc.)

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Please mail information form to:

For assistance please contact us at 206-650-3425 or email us at info@exoticbirding.com