Reservation Form

ROTARY 4851

In order to place your reservation, fill out all fields of the form below.

We will send a confirmation and the next steps to follow within 2 business days .

Reservation Information

Choose your trip(s) *
Select one or more trips that you wish to register for.
AMAZON EXPEDITION 2027 - D4851

May 17 to May 25

RIO DE JANEIRO 2027 - D4851

May 14 to May 17
Participant Details
You are: * First Name *Last Name *Nickname (name you like to be called) Country of Origin *Passport Country *Passport Number * Full Name * (Same as Passport)Select Date Passport Issued *Select Date Passport Expires * E-mail Address *Cell Phone No (with Country Code)Select Date of Birth *Gender * InstagramFacebookWhatsApp Exchange Year: *
Host Country Information
First Name of Host Parent #1 *Last Name of Host Parent #1 *Cell Phone No (with Country Code) E-mail Address *First Name of Host Parent #2Last Name of Host Parent #2Cell Phone No (with Country Code) E-mail AddressStreet Address *City *State/Province *Zip/Postal Code *Country *Host Family Home PhoneHost High School Name * Host High School City and State/Province *
Home Country Information
First Name of Natural Parent #1 *Last Name of Natural Parent #1 *Cell Phone No (with Country Code) E-mail Address *First Name of Natural Parent #2Last Name of Natural Parent #2Cell Phone No (with Country Code) E-mail AddressStreet Address *City *State/Province *Zip/Postal CodeCountry * Home Phone NoHome School Name *Home School City *Home (Sponsor) Organization *Home (Sponsor) District/Division
Medical Information
Name of Medical Insurance Company *Insurance Policy No. & ID No. *Allergies, if any *Medications, if any *Dietary Restrictions, if any *I have received my Covid-19 vaccine or I plan on receiving it at least 45 days before my first trip. * Yes No
Have you ever taken the yellow fever vaccine? * Yes NoIs there anything else regarding your health that we should know about (serious illness, surgery, etc.)?
General Information

Do you smoke? * Yes NoCan you swim? * Yes NoHave you had swimming lessons? * Yes NoT-shirt Size: * Pants Size: * How did you hear about ROTARY 4851 Tours with Belo Brasil Travel? * * I have read and I do agree with all of the terms of this trip's general conditions.
* This information is required.