Pilgrimage to Sri Lanka 2019 Registration

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You can download a copy of the contract for your records at https://goo.gl/EoCwk6

Full Name (Please write it *exactly* as written in your Passport) *

It is important to give the exact same name that is listed on your passport as this will be the name used on your Sri Lanka visa application.

Preferred name (or nickname)

Day of birth *

Month of birth *

Year of birth *

Complete Home Address (please include street address; city; state; ZIP code and country if outside the USA) *

Best phone number to reach you *

Just in case we need to get ahold of you more quickly than via email in an emergency only. Please include the country code if outside the USA or Canada.

Email address *

Please know that we rely solely on email to keep you updated about trip information.

Passport country of issue *

Passport number *

Expiration date of passport *

Important note: Your passport must have at least six months validity from the end of the trip and at least two blank pages in it. If you wish to register for this trip but have an expired or soon-to-be-expired passport, you can still enter your old passport info and we will update it when you send us the new information.

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Will you have a single room or a shared room on this trip? *

If you are willing to share but don't have a roommate already, we can let you know if others are in a similar situation. However, we can't guarantee that you will have a roommate.

I have a roommate but want separate beds

I have a roommate and will share a bed

I do not want a roommate and will pay the single supplement

I do not have a roommate but would like a roommate (though I understand if a roommate cannot be found I will have to pay the single supplement)

If you are sharing a room, what is your roommate's name?

Occupation & Interests: Please tell us more about you so we can make sure you get the most out of your time with us! We can help find little gems along the way that are in line with your interests. *

Emergency contact information *

Name; Relationship; Phone Number; Email

Food allergies (gluten, dairy, etc) / Dietary restrictions (vegetarian, vegan, etc)

Do you have any health conditions and/or severe allergies (food, drug, or environmental) we should be aware of? Do you use any medications you will need refrigerated or medical devices that require electricity?

Briefly describe your meditation practice.

What are you hoping to experience on this journey? How can we help you get the most out of your time with us? *

How did you first learn about this trip? *

Please read and sign the Tour Contract and Liability Waiver below.

I agree to the Tour Contract and Liability Waiver *

I agree

Required

Please sign below with your digital signature which consists of your full name *

Example: John Q. Sample

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