Checking off your bucket-list, one trip at a time

SOCOTRA TRAVEL FORM

Personal Information

Name (as spelled on the passport)

First Name

Last Name

Age:

Country:

Cell Phone Number (with country code)

Emergency

Emergency Contact:

First Name

Last Name

Relationship:

Contact Number (including country code)

Dietary Information

Food

Do you have any special dietary needs such as food allergies, low salt, low fat, low/no sugar, vegetarian etc.? Please be as specific as possible

Fitness and Medical History

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 list any medication allergies

Please provide any additional information that may be useful to emergency medical personnel in the event of an emergency

SOCOTRA FORM