May we ask where you first heard about Southern Crossings?

Nat. Geographic Adventure Magazine Nat. Geographic Online Travel Directory ASTA Buyers Guide Travel Agent Word of Mouth Yahoo Sponsor Result (paid listing) Yahoo search result Google Adwords (paid listing) Google search result MSN search result MSN paid listing Other search engine College and university advertising Other

Please choose your trip:        
                     

Custom trip Peru: Inca Blitz! Peru: Classic Inca Trail Peru: Active Inca Trail Peru: Inca Heartland Peru: Nazca Express Peru: Islands Express Peru: Amazon Adventure Peru: Andes Explorer Peru: Ruins and Rainforest Peru Explorer Trekking: The Sun Gate Peru Spring Break 2008! Trekking: Journey to Choquequirao Trekking: Inca Trail via Salkantay Trekking: Ultimate Inca Trails Trekking: High Andes Trekking Mayan Adventure Mayan Explorer Reef Madness Yucatan Splash Brazil: 21-Day Salute Brazil Explorer Brazil: Carnival 2008! Rafting: Apurimac Adventure Rafting: Rapids and Rainforest Biking the Inca Empire
 

Trip start date (mm/dd/yy):

Name as appears in passport:

Passport number:

Issuing country:

Gender:

Male  Female

Mailing address:

Country:

Daytime phone:

Evening phone:

E-Mail:

Date of Birth:

Jan Feb Mar April May June July Aug Sep Oct Nov Dec 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.  

  Yes, I would like single accommodations 

Vegetarian?

Yes No

Will you be needing additional accommodation before or after your trip?
City: Date in: Date out:
Single Shared

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 no.:          
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 we're arranging, etc.):
 

Medical conditions we should be aware of (i.e. allergic 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.

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. 

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