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Paradise in Panama Wellness Retreat

Contact Information:

First Name: *

Last Name: *

Email: *

Cell Phone Number: *

Address Line #1: *

Address Line #2:

Country: *

City/Town: *

State/Province: *

ZIP/Postal Code: *

Medical and Allergy Information:

Any food allergies? *

Any additional dietary preferences? *

Do you have any concerns about health conditions that might affect your ability to safely participate on the trip? *

Yes

What kind of exercise do you do and how many days a week? *

Other Information:

How did you first hear about Adventures in Good Company? *

Please tell us about yourself and why you chose this adventure! *

Before the trip, we send a list of contact information to all participants. If you would prefer to have your contact information excluded, please indicate below which parts to exclude.

Exclude your address? *

Yes

Exclude your phone#? *

Yes

Name of woman you'd like to room with, if any?

AGC Agreement, Terms and Conditions:

In this section, you will provide an acknowledgment regarding your trip choice and preparedness. Please consider whether you have chosen a trip that will meet your expectations and abilities. Whether in conjunction with your medical provider or not, you should consider the trip's activities carefully and assume full responsibility for selecting a trip that's suitable for your abilities.

In addition, you will need to read and sign the Booking Terms & Conditions, and the Assumption of Risks & Release and Indemnity Agreement below. Please read each document carefully, as they contain important information associated with your trip and must be signed by you. Your electronic signature below constitutes your agreement to be legally bound by the terms of each of these documents.

Electronic Signature: By typing my name and the date and clicking the ‘I agree’ checkboxes below, I understand that I am entering into, and accepting the stated terms, conditions, and agreements as a legally binding agreement.

I have read the itinerary & rating system and agree that I have or will have the conditioning and experience required for the trip. *

I agree to the Booking Terms & Conditions *

I agree to the Acknowledgement and Assumption of Risks & Release and Indemnity Agreement. *

Your Full Name *

Date *

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Paradise in Panama Wellness Retreat

Trip Registration:

Contact Information:

Medical and Allergy Information:

Other Information:

AGC Agreement, Terms and Conditions:

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