Trip Application

your expedition	pygmy blue
trip date
information
date of birth *	month day year
special code	leave blank if none
first name *	last name *
e-mail *
city *	state * country *
postal code *	work phone
home phone *	mobile phone
	date of passport *
passport place of issue *	passport nationality *
vegetarian	where have you been traveling or diving in the last three years?
have travel insurance (strongly recommended)	1)
have diving insurance (strongly recommended)	2)
	3)
	4)
	5)
payment	non-refundable deposit required = 33% of trip price expedition pricing = i. $ 9,400 per person ii. $ 7,400 per person iii. $ 7,400 per person / 33% = $X,XXX deposit
	payment amount deposit ($X,XXX) full payment (i. $ 9,400 per person ii. $ 7,400 per person iii. $ 7,400 per person)
	payment method paypal bank transfer check