Southern Crossings Booking Form

Trip start date (mm/dd/yy):

Name as appears on passport:

Passport number:
NOTE: IF YOUR PASSPORT NUMBER CHANGES, IT IS IMPORTANT TO NOTIFY US IMMEDIATELY.  IF YOU ARE HIKING THE INCA TRAIL, YOU MUST HAVE AT LEAST A COPY OF THE PASSPORT WITH WHICH WE PROCURED YOUR INCA TRAIL PERMIT.

Issuing country:
Gender:
Male Female
Mailing address:
Country:
Daytime phone:
Evening phone:
E-Mail:

Date of Birth:

 Day:  Year:

Emergency contact name and complete Telephone # :

If traveling alone, or would like single accommodation, please check the box and add to your payment the single supplement amount found in the “Trip itinerary and details” section of each trip. 

City:
Date in:
Date out:
Single Shared If you know your international flight information, please fill it in below.  If not, please provide us with that information as soon as it is confirmed.

Arriving Flight:

Airline:

Flight # :

Arrival date:

Arrival time:

Departing flight:

Airline:

Flight no:

Departure date:

Departure time:

Additional info we need to know (i.e. joining or departing earlier or later, extra days somewhere, extra activities you’re interested in, etc.):

Medical conditions we should be aware of (i.e. allergies to bees or peanuts, sensitive to altitude, diabetic, etc.)

Please note that while we like to know about any medical conditions our passengers may have, this knowledge makes us in no way responsible for any occurrences while on tour, and it is solely the passenger’s responsibility to carry the medication they may require and to avoid any situations that may put them in peril.

Acknowledgement and acceptance of the Terms and Conditions of Southern Crossings Tours and Travel must be indicated by checking the box below and by signing a copy of the Terms and Conditions on Arrival Day of your tour.

Click here to read Terms and Conditions (then just close the window to return here).

I have read and understand the Terms and Conditions of Southern Crossings
Tours and Travel:

Yes No
I understand that travel medical insurance covering personal accident, emergency evacuation and repatriation expenses is mandatory on all Southern Crossings adventure tours and I will possess such insurance throughout the dates of the above listed trip.  (Note: you may go ahead and fill out this form, and then notify us of your insurance details when you have them.)

Please check: Yes, I will possess travel medical insurance throughout my Southern Crossings trip.

Important: we will need a scanned copy of the photo page of your passport as soon as possible in order to make all of your bookings.  You may email this to us at info@southerncrossings.com or fax to us at 1-888-232-7728.

Thank you!  You will be contacted by email or telephone shortly to confirm your booking.