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Inscription form

You must not fill this bulletin that once your taken decision to reserve your trip with us.

This inscription bulletin is so important for us as for you for it is the basis for a good sequence of your future travel with Puka Nina. A bulletin by person will have to be filled and sent through this inscription form, that we will receive by e-mail after validation on your part at the bottom of form. It is therefore essential for us that you filled with cares the fields that you can fill. The infos in duplication (same insurance for all the participants for example, same address) will be able to be filled on a principal bulletin but it will be necessary about it to fill a by in a manner obligatory participant.
Thank you therefore to fill it with the biggest care.
Fields with ( • ) are necessary.

Form to fill carefully

Grup : •
Surname : •
Name : •
Selected program :
Passport :
Nationality : •
Date of birth :
day     month     year   •
Arrival airline :
Flight number :
Date :
day     month     year  
Arrival time :
  hh     mm
Departure airline :
Flight number :
Date :
day     month     year  
Departure time :
  hh     mm
Email : •
Alternative email :
Tel :
Cel :
Fax :
Address :
City & postcode :
Country of residence :
Profession :
Ensurer :
Contract number :
Ensurer address :
City & postcode :
Tel 1 :
Tel 2 :
Tel 3 :
Fax 1 :
Fax 2 :
Fax 3 :
Things we should know (eventual diseases, allergies, food preferences, etc.) :
Person to notify in case of disaster 01 :
Tel :
Email :
Person to notify in case of disaster 02 :
Tel :
Email :
Person to notify in case of disaster 03 :
Tel :
Email :
Hotel reception if mudule :
Hotel address :
Rooming desired :
     


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PUKA NINA PERU
Plaza Amauta 210 Of. 304 Magisterio | Cusco Perú | Telefax: + 51 84 240975
Razón Social: Puka Nina Perú S.A.C. | RUC # 20527409757 | Licencia Municipal # 006516 | Licencia de turismo # 220-2009-GR Cusco- Dircetur- DT

http://www.pukanina.com/
perou@pukanina.com