Copper Canyon Trip Sign Up Form

Please complete this form and send via the submit button at bottom of page. This information is required. Please fill out all fields marked with a red asterisk, even if only NA for not applicable.

Privacy Note: Santiago will not share your private information with anyone. We keep this information in our files. It is used solely by us to provide the best possible travel service for you.

An email copy of the information in this form will be sent to you automatically.

* Name of Trip:

* Trip Dates:

*Are you a smoker? Yes No

* Name

* Male/Female:

M F Date of Birth:

* Address:

Address 2:

* City:

* State/Province:

* Zip/Code:

Country (if not US):

* Home Phone:

(please indicate country code plus area code if outside U.S. or Canada)

* Day Phone:

(please indicate country code plus area code if outside U.S. or Canada)

* E-mail:

Fax:

Name on Passport:

Expires:

Passport Number:

Place & Date Issued:

* Citizenship:

If you are not a U.S. citizen it is your responsibility to check with your consulate regarding entry requirements for your destinations.

Medical Information

It is the responsibility of each person to prepare adequately for traveling. Please consult with us if you have concerns about your physical capabilities and the planned active vacation. If you need to elaborate on the questions below, please use the comments box.

* Do you have any medical problems or history that could pose any difficulties with your participation in this trip? Yes No

If yes, please explain:

* What medications will you bring?

* Any dietary considerations?

* Height: Weight: Does your medical insurance cover you in Mexico? Yes No

* In case of emergency notify:

* Emergency work ph: Emergency home ph:

Accommodations

I am traveling with:
We are sharing a room: Yes No

I am traveling alone and would like to be paired with a: Male Female Either

I prefer a single room, if available and will pay the extra charge. Yes

* I am interested in these types of activities: (check all that apply)

Photography/Film	"El Chepe" train	Canyoneering
Backpacking	Day hikes	Treking/Camping with burros
Homestay	Cultural Adventures	Natural History Adventures

How did you hear about us?

Have you traveled with us before? Yes No
If yes, describe:

Do you speak Spanish? Yes No If yes, at what level?

Comments or questions:

Yes, I'm interested in receiving periodic Copper Canyon news and updates by e-mail.

* I have read and agree to the terms and conditions Yes No

* I will be paying my $400 trip deposit by: check money order PayPal

Travelers outside the U.S. or Canada may pay with a credit card via the Paypal secure web site. You must first open a free Paypal account to use the service. Once you have established an account you may then use the Paypal button on the terms and conditions page for a direct link to our Paypal account.
All US & Canada travelers can use the button on the terms and conditions page whether you already have an account or not. There is a button on the PayPal form for new domestic accounts.

Thank you for taking the time to fill out this form. Please take a minute to review the above information for accuracy before continuing.
If you are paying your deposit by check or money order, please MAIL a copy of the EMAIL RECEIPT that you will receive immediately upon clicking the send button with your check.

Santiago James Barnaby
La Cooperativa de los Guias Alta y Baja Tarahumara

Cell: 406-570-0570 | PH: 406-587-3585 | P O Box 203 | Bozeman, MT 59771

Copper Canyon Trip Sign Up Form

Medical Information

Accommodations

Santiago James Barnaby La Cooperativa de los Guias Alta y Baja Tarahumara

Santiago James Barnaby
La Cooperativa de los Guias Alta y Baja Tarahumara