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Checking off your bucket-list, one trip at a time
All Trips
Sign Up
Trip Reviews
About
Contact
Instagram
0
MADEIRA 1 TRIP FORM
MADEIRA TRAVEL FORM
Personal Information
Name
*
First Name
Last Name
Birth date:
*
Age:
*
Country:
*
Cell Phone Number (with country code)
*
Emergency
Emergency Contact:
*
First Name
Last Name
Relationship:
*
Contact Number (including country code)
*
Arrival Information
Do you have a valid Schengen Visa?
*
If you do not require a Schengen Visa, please check YES
YES
NO
Date of Arrival to the Airport
*
MM
DD
YYYY
Time of Arrival to the Airport
*
(please include a.m. or p.m.)
Flight Number
*
Please add Flight Number arriving to the Airport
Departure Information
Date of Departure from the Airport
*
MM
DD
YYYY
Time of Departure from the Airport
*
(please include a.m. or p.m.)
Flight Number
*
Please add Flight Number departing from the Airport
Fitness and Medical History
What is your physical fitness level?
*
How often do you exercise and what type of sport you like to practice?
*
Please list previous medical/psychological conditions which may affect your fitness level
*
Do you have any heart related conditions?
*
Please list any medications you are taking
*
Please provide any additional information that may be useful to emergency medical personnel in the event of an emergency
*
I have reviewed the complete itinerary and comprehend the hiking levels, distances, locations, and overall nature of the trip
*
Accept
Decline
See you in Madeira!
