Exotic Birding Information Form
PARTICIPANT INFORMATION
Participant Name: _____________________________________________________________
Emergency Contact Name(s), Relationship, and Phone Numbers:
_____________________________________________________________________________
_____________________________________________________________________________
Pertinent Medical Information We Should Know About:
_____________________________________________________________________________
_____________________________________________________________________________
Disabilities, illnesses, or other
limitations that might restrict full participation in the tour:
If yes, please describe: __________________________________________________________
______________________________________________________________________________
Dietary restrictions or other special:
______________________________________________________________________________
PASSPORT INFORMATION
Participant
Name as it Appears on Passport: __________________________________________________
Nationality & Passport Number: _________ Passport Number: ______ Expiration: __________
Occupation (Former if Retired): ____________________________________________________
Place of Issue: _____________________________________________ Date of Issue: _________
Place of Birth: _____________________________________________ Date of Birth: __________
Additional Participant or Companion
Name as it Appears on Passport: __________________________________________________
Nationality & Passport Number: _________ Passport Number: ______ Expiration: __________
Occupation (Former if Retired): ____________________________________________________
Place of Issue: _____________________________________________ Date of Issue: _________
Place of Birth: _____________________________________________ Date of Birth: __________
FLIGHT INFORMATION
Scheduled Arrival at Start of Tour: Airline/Flight #: _____________ Date/Time _____________
Scheduled Departure at End of Tour: Airline/Flight #: ______________Date/Time _____________
OTHER INFORMATION (e.g. Non-birding Activities Desired During Tour, Special Requests, etc.)
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Please submit this form via email or postal delivery. Our address is below:
Jim Wittenberger
Exotic Birding LLC
86
For assistance please contact us at 206-650-3425 or email us at info@exoticbirding.com