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Your Details

( required for adventure insurance )

Personal Details  ( please copy this text and paste in the box below )
First name:
Family name:
Date of birth:
Nationality:
Passport number:

 

Personal details

Contact Details

Medical info

Any food restriction?
yesno

Any allergy, disease or medication we should know?
yesno

Do you swim well?
yesno

Do you know CPR techniques ?
yesno

Extra medical info:

Travel details

If you do not know this information yet, please send us afterwards.

Are you planning to arrive with the night bus ? If yes, read something about this in the FAQ
yesno

Your Arrival date and time:

When are you leaving Lençois ?

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