Birding Albania – Tour Participant Information Form

All information provided in this form will be treated as strictly confidential and used only for the organisation and safety of the tour.

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TitleMrs.Miss.Mr.Dr.Prof.

Name *

First

Last

Date of Birth *

Date/month/Year

Nationality *

Passport number *

Passport expiry date *

Address *

Mobile name Passport

Country *

Mobile phone *

Email *

Emergency contact name *

Please provide the name of the emergency contact person and the relationship

Phone number *

Please provide the phone number of the emergency contact person

Insurance company *

Policy number *

Emergency insurance phone *

Medical Assistant Contact *

Please provide the name and the phone number of your medical assistant

Do you have any medical conditions that the tour leader should be aware of? *NoYes

If yes, please specify

Medical conditions; Allergies; Medications you regularly take (optional)

Dietary Requirements *NoneVegetarianVeganGluten FreeOther (please specify)

If other diet requirements please specify

Accommodation Preference *Single RoomShared Double RoomShared Twin Room

If sharing a room, please indicate the name of your roommate:

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