Customized Journeys Registration Form

Registration Form
Please complete this form and submit it. A non-refundable* $700.00 deposit per person is required to reserve space(s) on the departure date designated below. Please be aware that some travel insurance policies and/or upgrades must be purchased soon after you make your deposit. For more information on the plans we offer through Travelex Insurance and to receive an instant quote, visit our Travel Insurance page.

*In the event of tour cancellation by the company due to lack of sign-ups (i.e. minimum participants not met), deposits can be transferred to another trip or will be refunded in full. In the event of tour cancellation due to an emergency or safety reasons, you can rebook on another trip of your choice or we will issue you a voucher to be used towards future travel. Otherwise, all deposits are non-refundable.
Method of Payment:
If paying by check, please send to:
Customized Journeys
25 NW 23rd PL. - Suite 6 - PMB #478
Portland, OR 97210
USA

If paying by credit card, please call:
1 (503) 914 6452 or 1 (971) 344 7457
Destination
Departure Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Extension (if applicable)
Name (Exactly as it appears on your passport)

First & Middle Name Last Name
Additional Traveler Names
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Daytime Phone Number

Area CodePhone Number
Work Phone Number

Area CodePhone Number
Mobile Phone Number

Area CodePhone Number
Evening Phone Number

Area CodePhone Number
Primary Email
Secondary Email
example@example.com
I would like to share a room with:
I desire a single room throughout the tour:
Passport Information
Given Name on Passport

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
City of Birth
State of Birth
Citizenship
Passport Number
Issuing Country
Date Issued

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Expiration Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Traveler B
Given Name on Passport

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
City of Birth
State of Birth
Citizenship
Passport Number
Issuing Country
Expiration Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Date Issued

MonthDayYear
2 digit month, 2 digit day, 4 digit year
By submitting this form, you agree that you have read and agree with Customized Journeys’ terms and conditions (available on our website or in pdf form upon request) and declare that I am able to walk four miles a day at a leisurely, unassisted pace. Please note that some trips (e.g., hiking focused trips) may require more walking. Such trips will list specific hiking requirements.
Customized Journeys - 25 NW 23rd PL. Suite 6 PMB # 478 Portland, OR 97210
Tel. 503. 914. 6452 - www.customizedjourneys.com -info@customizedjourneys.com
Should be Empty:

Registration Form

Passport Information

Traveler B