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 ?