Accepted Application Additional Info

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Birth Date*

Cell*

Email*

Enter Email Confirm Email

Please recall travel insurance is required. You may purchase a plan through whichever carrier you wish. We do, however, have a partnership with Travelex so if you wish to use them you can purchase directly through this link.

Travel Insurance Carrier*

Travel Insurance Confirmation Number*

Any known allergies (medical, food, etc.)?

Any dietary restrictions?

Do you smoke?

Yes
Sometimes
No

Do you drink alcohol?

Any medical conditions we should know about (including physical injuries and/or ailments)?

Have you received the COVID-19 vaccination?*

Yes
No

Please upload a picture of your COVID-19 vaccine card*

Max. file size: 256 MB.

Proof of a negative PCR test result taken within 48 hours of your trip start date is required. Please forward the PCR test result via email to info@travendly.com

Emergency Contact #1

Name*

Cell*

Relationship to you*

Emergency Contact #2

Name*

Cell*

Relationship to you*

Additional Information

Emergency Contact #1

Emergency Contact #2

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