GRAND CANYON RAFTING TRIPS Tour West Grand Canyon 3 Night Passenger Information Form Subscribe Tour West Grand Canyon 3 Night Passenger Information FormTrip DatePlease fill out EACH section of the form (one person per page). This information is necessary for our records, is REQUIRED BY THE NATIONAL PARK SERVICE and will help us to better accommodate your needs.First NameLast NameFull Mailing AddressAddress Line 1Address Line 2CityStateZip CodeCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)ReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwePhone/MobileEmailBirth DateAgeWeightHeightIn case of emergency, contactFirst NameLast NamePhoneRelationship To YouDo you have any medical conditions, take any medications, have any allergies or disabilities we should be aware of? If yes, please describe. (If you do not want to disclose this information please sign below to acknowledge that you do not hold Tour West responsible for the information):Do you have dietary restrictions? Please explain and give specifics of foods you DO NOT eat and those you DO eat.Please answer the following questions:1. Cell phone # where you can be reached as you travel to and from your river trip2. Do you need optional Las Vegas to Marble Canyon flight before your trip (not included in trip price)? Yes No3. What are your preferred room accommodations at the Marble Canyon Lodge for the first night (i.e. single room, two people one bed, two people two beds, etc.)?4. Where would you like to be returned after your trip? Las Vegas Marble Canyon5. Do you have an Annual or Lifetime National Park Pass? If yes, card number & expiration date:6. Did you purchase cancellation insurance through Allianz Travel Insurance? Yes No7. If we take photos during your trip will you allow Tour West to use your image for advertising purposes? Yes No8. How did you hear about Tour West? Internet/ Newspaper/Magazine/ Travel Agent /Friend/ OtherTour West Cancellation PolicyDeposit is non-refundable. Cancellations between 60 and 31 days prior to your departure forfeit one half the tour cost.Cancellations between 30 days and the day of your trip lose the entire tour cost. No shows lose entire tour cost. This policyapplies per person. We are firm with this policy and suggest you purchase travel insurance. This will help reimburse you inthe event of illness or other unforeseen reasons for canceling. Travel insurance is available on our website www.twriver.com or we can mail you a form. For optimal insurance coverage, purchase insurance within 14 days of paying deposit.Please read and sign that you understand and accept our cancellation policy:Signature Sign Here Signed DatePLEASE RETURN A.S.A.P TO Tour WestMAIL: P.O. Box 333 Orem, UT 84059 FAX : 801-225-7979 EMAIL: twriver@aol.comSubmit Form