EmailMe Form - Booking Form

Tour Information

Tour Name: *

You can select multiple tours if you are going on more than one. Just hold down the control key (command key for mac users) as you make your selectiion.

Tour Departure Type: *

Group Departure

Private Departure

Other

Tour Start Date: *

MM / DD / YYYY

About You

First Name *

Please enter your name as it is on your passport.

Last Name *

Please enter your name as it is on your passport.

Preferred Name *

Please list the name you would like to be called.

Gender *

Male

Female

Date of Birth *

MM / DD / YYYY

Nationality *

Passport Number *

Passport Expiration Date *

Email *

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone

Occupation

Dietary & Medical Information

Dietary Requirements *

Omnivore: I eat everything

No Red Meat: I eat chicken & fish, but no red meat

Fishatarian: I eat only fish, no meat or chicken

Vegetarian: I eat only veggies, eggs & dairy

Vegan: I eat only veggies, no animal products at all

Absolutely every effort is made to accommodate dietary request, but please keep in mind the nature of the islands especially and the already limited variety of food.

Please list any additional dietary requirements or food allergies.

If your food allergy is severe, please let us know.

Please list any non-food allergies, pertinent medical history and all medications currently being taken. *

Have you received the full Covid-19 vaccination?

Yes

No

Rooming Preference

Please indicate your rooming preference. *

Single Supplement (Single traveler paying for private room)

Single Traveler (Willing to share a room with a same sex rooming partner)

Matrimonial (one shared bed)

Double (two single beds)

Family (one shared bed for parents, one single bed for a child)

Triple (three beds)

Quadruple (four beds)

Who will be your rooming partner(s)? *

Please put your rooming partner's full name and relationship.

If you are a single traveler without a single supplement please enter "sharing" for your rooming partner.

If you are paying a Single Supplement - put Single Supplement.

Diving

Are you interested in diving during your Galapagos Trip? *

Yes

No

You must be a certified diver in order to dive in Galapagos.

Pre and Post Trip

If your planning on an extra afternoon or few days before or after our trip, we'd be happy to help you with any pre and post activities and accommodation.

Are you interested in any Pre or Post trip activities in or around Quito? *

Yes

No

Maybe - please let me know my options.

Please select which pre/post tours you are interested in.

You can select multiple tours if you are interested in more than one. Just hold down the control key (command key for mac users) as you make your selectiion.

Do you need Pre-trip accommodation? If so, how many nights?

Do you need Post-trip accommodation? If so, how many nights?

Emergency Contact

No emergencies are expected, but just in case...please share someone we can get in touch with if needed.

Name *

First Last

Email

Phone *

If you are providing a non-US phone number, please include the country code if possible.

Relationship *

Final Details

How did you find us? *

Any more details on how you found us? Particular site, book, article, etc.

*If you were referred by a friend, please let us know who to thank.

Is there anything else you'd like us to know?

Which member of the Galakiwi staff has been your main point of contact? *

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