Registration Small World Trip Registration Form Use this form to register for a Small World Trip in Ecuador whether you are Kayaking, Rafting or Adventuring. Have your flight information, passport info, trip information and emergency contact information handy. Grand Canyoneers don't need to fill out this form but if you love forms then go for it! Personal InformationName First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email PhoneAgeHeight (approx)Weight (approx)Birthday MM DD YYYY mm/dd/yyyyTrip InformationTrip NameTrip Date Primary ActivityKayakingRaftingAdventuringPassport InformationYour passport needs to be valid for six months after your trip.Passport NationalityPassport NumberPassport Expiration MM DD YYYY Emergency Contact InformationPlease leave the name and number of a person we can contact in the case of an emergency.Contact Name First Last Contact Email Contact NumberContact RelationshipMedical InformationThe trips are strenuous and all participants need to be in very good physical condition. We recommend that all trip participants schedule a physical exam within 2 months prior to departure. Discuss the activities and location of the trip, and take the doctor’s advice. If you are not comfortable disclosing information here then schedule a call with the office to discuss.Physical ImpairmentYesNoDo you have any physical conditions that would prevent you from fully participating in this trip? If you check Yes, please provide detail below.DetailsPlease sure any details here that you think we should know. Medications you may need, allergies we should know about, recent operations, etc. Put it here or talk to us in private.Lodge StuffLet us know how you like to eat, sleeping arrangements.DietCarnivoreVegetarianVeganFood NotesAnything else you would like to share about your dietary restrictions, food allergies etc.Room choices Request Private Room (additional $200 per week and subject to availability) Want to share with a particular person Surprise me! If you wanted a particular roommate then enter their name here. First Last Flight and HotelName of Arrival Airline, Flight NumberArrival Date Arrival Time : HH MM AM PM Name of Departure Airline, Flight NumberDeparture Date Departure Time : HH MM AM PM River ExperienceNumber of years boating?How many days have you boated this season?List the most difficult rivers that you have boated this year. River, # of runs, water level, describe your day on the river (i.e. Easy, portaged 1)My practice roll worksneversometimesusuallyalwaysMy combat roll worksneversometimesusuallyalwaysI enjoy leading friends down technical runs of difficultyClass IIClass IIIClass IVClass IV+I enjoy leading friends down big water runs of difficultyClass IIClass IIIClass IVClass IV+I am comfortable and in control on technical runs up toClass IIClass IIIClass IVClass IV+I am comfortable and in control on big water runs up toClass IIClass IIIClass IVClass IV+Will you bring your own kayak?YesNoMake three choices of kayak. Open list in new window (don't close this one) http://www.smallworldadventures.com/kayaksTrip InsuranceLast question (you are so patient): Trip Insurance I Promise to look into trip insurance I have read the Cancellation policy on the Signup page Every year we have guests that at the last moment can't make the trip for valid reasons and don't have trip insurance. Small World wants to help but we are unable to issue refunds in such situations. Please purchase trip insurance, it is not expensive and doesn't take long.Signature Thanks Small World Adventurer!!Extra NotesAnything else you would like to let us know. Thanks, don't forget to Submit below!!PhoneThis field is for validation purposes and should be left unchanged.