Southwind Adventures - Trip Reservation Form

Travelers residing at different addresses should complete separate forms.
For additional travelers, please fill out necessary information on additional forms.

We respect your privacy. All information will be used solely by Southwind Adventures and our associated offices in South America, and will not be rented or sold to any individual or company.

* required fields.

Trip Information

* Trip Name:
Dates:
* Traveler's Name: (as it appears on passport)
Second Traveler's Name: (as it appears on passport)

Contact Information

Mailing Address:
City:
State/Province:	Other:
Zip/Postal Code:

Country:	Other:
* Email:
* Day Phone:
Cell Phone:

Traveler 1 Information

Age: Gender: Height: Weight: Smoker:
Citizenship:	Other:	Date of Birth:
Passport Number:		Exp. Date:
T-Shirt Size:

Traveler 2 Information

Age: Gender: Height: Weight: Smoker:
Citizenship:	Other:	Date of Birth:
Passport Number:		Exp. Date:
T-Shirt Size:
Email:		Cell Phone:

In Case of Emergency

Contact Name:
Relationship:
Phone:
Alternate Phone:

Accommodations

I will share with:

Where available we prefer:

Twin Beds
King/Queen Bed

Travelers who occupy single accommodations either by choice or circumstance must pay the single supplement.
	I am traveling alone. Please assist in finding me a room and/or tentmate (I agree to pay the single supplement if no roommate is available).
	I am traveling alone and prefer single accommodations whenever possible and understand that there is an additional charge.

Air Transportation

Southwind trips DO NOT INCLUDE INTERNATIONAL OR IN-COUNTRY FLIGHTS (unless indicated otherwise in the Published Trip Itinerary or Custom Trip Proposal). Upon receipt of your deposit, SWA will provide recommended arrival/departure dates and times as well as options for booking your flights through our affiliated ticketing office.

Additional Information

How did you hear about Southwind Adventures? Please be specific (e.g. name of referral, publication, internet search engine, website, etc.).
Comments/Questions/Requests/Additional Services:

Deposit and Payment Information

This section is for deposit information only, you will receive instructions from your Travel Consultant on how to pay the balance. If your total deposit is higher than $2,000, please contact our office directly for payment arrangements and select "By Phone" under Form of Payment below.

Form of Payment:
Name on Credit Card:	First: Last:
Credit Card Number:
Expiration Date:
Card Verification Number:	What is this?
Total Payment: USD $
Billing Address:
Billing Zip:

Payment of your deposit indicates an understanding of and acceptance of the Terms & Conditions, those in the Release of Liability, and those described on each detailed itinerary. They define SOUTHWIND'S RESPONSIBILITY with respect to all of our programs. PLEASE READ THEM CAREFULLY.

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Once completed, you may print a copy of this page for your records.

All Southwind travelers are required to sign Southwind's Assumption of Risks and Release of Liability.

Clicking submit will send your information via a secure order form & will charge your credit card if that option was chosen. You will promptly receive a charge confirmation by email, if you do not please contact our office. Be sure to click submit only once.

Thank you for your reservation!