First and last name

Email address

Phone number

Date of birth (mm/dd/yyyy)

Street address

City, state, zip

Emergency contact

Phone number

Which trip do you plan to register for? Which trip do you plan to register for? Balkans Beauty and Culture (May 2026) Africa Adventure (August 2026)

How would you describe your overall health? How would you describe your overall health? Excellent Good Fair Poor

Do you have any chronic medical conditions (e.g., heart disease, diabetes, respiratory issues, mobility limitations)? Do you have any chronic medical conditions (e.g., heart disease, diabetes, respiratory issues, mobility limitations)? Yes No

If yes, please specify

Have you had any hospitalizations or surgeries in the past 12 months? Have you had any hospitalizations or surgeries in the past 12 months? Yes No

If yes, please specify

Are you able to walk at least two miles over uneven ground without assistance or significant discomfort? Are you able to walk at least two miles over uneven ground without assistance or significant discomfort? Yes No Unsure

Are you able to climb stairs and manage moderate inclines without difficulty? Are you able to climb stairs and manage moderate inclines without difficulty? Yes No Unsure

Do you use any mobility aids (e.g., cane, walker, wheelchair)? Do you use any mobility aids (e.g., cane, walker, wheelchair)? Yes No

If yes, please specify

Do you have any conditions that may limit your participation in group travel activities (e.g., long walking tours, airplane or boat or bus trips, or sensitivity to altitude or heat or humidity)? Do you have any conditions that may limit your participation in group travel activities (e.g., long walking tours, airplane or boat or bus trips, or sensitivity to altitude or heat or humidity)? Yes No

If yes, please explain

Do you have any allergies (food, medication, environmental)? Do you have any allergies (food, medication, environmental)? Yes No

If yes, please explain

Do you have any dietary restrictions? Do you have any dietary restrictions? Yes No

If yes, please explain

Is there anything else we should know to ensure your safety and comfort during travel?

I certify that the above information is true and accurate to the best of my knowledge. I certify that the above information is true and accurate to the best of my knowledge. Yes