Please indicate which The West Less Traveled tour you will be joining:

Tell about yourself:

Name:
Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
E-mail:
Citizenship:
Passport Number:
Passport Expiration Date:

  I will be rooming with my travel partner:
  I will be traveling solo. Please match me with a roommate.

Date of Birth:
Name as it appears in your passport:
How you would like to be contacted:
Emergency Contact Name:
Emergency Contact Telephone Number:
Relationship to Emergency Contact:
Fitness Level:
 Excellent
 Above Average
 Average
 Fair
 Poor

Dietary Option:
 Traditional/Local
 Vegetarian

Do you have any food allergies or restrictions?
 Yes
 No

PLEASE NOTE: DUE TO SMALL GROUP SIZE SMOKERS CANNOT BE ACCOMMODATED.

Medical Information:
What is your current health condition?

Do you have any injuries or medical conditions that would affect your participation in tour activities?

Special needs?

Other:
What attracted you to Celtic Heart Tours?

What is your travel experience?

Please list a few hobbies and interests.

What is one thing you would like your fellow travelers to know about you?

TERMS AND CONDITIONS: Please click button to read the Celtic Heart Tours Terms and Conditions; you can download the PDF there. We highly recommend you print and keep it with your travel papers.   TERM AND CONDITIONS


If registering electronically, clicking the SUBMIT button below for your registration implies consent to the terms and conditions.