Wild Papua Tour 2017

To register for this tour please fill out the following form and click "Submit". You will be emailed shortly with payment details (via bank transfer). Registration is only valid after confirmed by reply email and deposit has been received.

First Name
Last Name
Be sure your name is written EXACTLY as it appears in your passport.
Address
City
State/Province
Zip/Postcode
Country
Telephone
Email
Gender
Date of Birth
Passport No.
Nationality
Room Type Twin/share
Double
Single
Rooming With (optional)

Medical Notes
If you have any pre-existing medical conditions that may affect your ability to participate fully in this trip, please describe them here.

Allergies (if any)
Emergency Contact Name      
Emergency Contact Phone #  

Meal Restrictions (if any)

Questions or Comments

Terms and Conditions

1. All participants will be required to sign a standard liability release form acknowledging awareness and acceptance of necessary risks undertaken during the course of the trip.

2. All participants are responsible for arranging for their own travel insurance covering medical, baggage, and cancellation liabilities.

3. The tour operator reserves the right to cancel the trip for any reason. In the event of trip cancellation by the tour operator the client will receive a full refund of all payments.

Tick this box if you have read and agree to the Terms and Conditions outlined above.
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