EduTour Traveler Information Form • Ceiba Foundation

Personal Information

Name*

Please enter your full name exactly as it appears on your passport

First Middle Last

Email*

Enter Email Confirm Email

Phone*

Birthdate*

MM

DD

YYYY

Country of Citizenship*

I am a citizen of...

Passport Number*

Please enter your passport number. We need your passport number to make in-country flight reservations. If you do not yet have a passport, enter "Do Not Have", and send us an email with your passport number as soon as you get it. Note that you cannot travel to Ecuador without a passport!

Passport Expiration Date*

Please enter the expiration date on your passport. Note that to travel internationally, your passport must be valid for 6 months after the date of your return to the U.S.

MM

DD

YYYY

Upload Passport Photo Page:

Securely upload a clear color copy or scan of the photo page of your passport (max. file size 2 MB). A photo taken on your phone is fine if it is clear enough to read the text. Why do we need this? We require a copy of your passport to purchase tourist transit cards in advance for Galapagos, and to obtain prior authorization from the oil company for your transit through to Tiputini. We will destroy this file as soon as it is no longer needed. If you do not yet have your passport, please be sure to share a copy with us via a secure file sharing service such as Box or Google Drive as soon as you get it.

Diet and Allergies

Food Preferences*

Please indicate all the foods you WILL eat. Note: If you leave any of these food items unchecked, we will request that you are not served these items during the trip.

Beef
Pork
Chicken
Fish
Seafood (non-fish)
Eggs
Dairy
I eat NONE of the above

Special Dietary Restrictions:*

In order to best meet your dietary needs, please select any conditions you would like us to pass along to our chefs. If you have no restrictions, select "No special restrictions".

Vegan
Gluten free
Lactose intolerant
Food allergy
Other special restriction
No special restrictions

Food allergy or other special restriction

Please describe the nature of your food allergy or other special dietary restriction. Include a list of specific foods to which you are allergic.

Emergency Contacts

Name of Primary Emergency Contact*

Please give the name of the first person we should contact in case you are involved in an emergency.

First Last

Relationship to you*

Emergency Contact Email*

Emergency Contact Daytime Phone*

Emergency Contact Nighttime Phone

Leave blank if day and night phone are the same.

Emergency Contact Location*

Please enter the City, State, and Country where your emergency contact is located.

Back-up Emergency Contact

If you would like to give us a second emergency contact in the event that your primary contact is unavailable, please enter the person's name, email address, and phone number(s) below.

Submit Form

Submit another form?

Every person in your party must submit a form.

Check this box if you want to fill out a form for another member of your party after submitting this form.

Email

This field is for validation purposes and should be left unchanged.