Legal Name *

First Name

Last Name

Current Residential Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone *

(###)

###

####

Gender *

Male

Female

Birthdate *

MM

DD

YYYY

Emergency Contact Name *

First Name

Last Name

Emergency Contact Cell Phone *

(###)

###

####

Passport Expiration Date *

MM

DD

YYYY

Customs *

Do you agree to respect the customs of the host country, to follow group protocol on gifts, to dress and behave modestly at all times and to defer to the local guides? These customs can include people giving you the best seat, an expectation of wearing long pants even when its hot, and of hugging. People may ask you for gifts or personal information, which you would defer to your trip preparation / training for.

Yes

No

US Travel Advisory Status *

Have you reviewed the current US travel advisory status, and are you aware that traveling to Uganda is a personal decision with risks that can not be held or managed by any person or group and that while all attending this trip will help one-another in any way they can, any personal emergency is the responsibility of you as the traveler? https://travel.state.gov/content/travel/en/international-travel/International-Travel-Country-Information-Pages/Honduras.html

Yes

No

Committment *

I agree to go on this trip and pay the $2,000 per person fee ($1,000 deposit and $1,000 final payment) before the trip. I will cover my airfare to Palmarola (XPL) airport in Honduras and transportation to and from my location to an airport near me.