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Your 2022 Fishing Trip Details:

Trip Date*:

Group Leader:*

Your Contact Details (as shown on I.D. for charter air travel)

Salutation:

First Name:*

Last Name:*

Date of Birth:*

Email Address:*

Primary Phone:*

Address:*

City:*

Zip/Postal Code:*

Country:*

Personal and Travel Details (optional)

Dietary Requirements or Allergies:

Health or Mobility Considerations:

Pre-departure Hotel:

Your Fishing Information: (this information will allow us to tailor your trip to your experience level)

Rain Gear Size – Child

Rain Gear Size – Adult*

Boot Size (Adult)*

Level of Fishing Experience*

What other Areas or Lodges you have fished in the past

What Handed fishing reel do you prefer:*

Will you be brining your own fishing rod? (If yes, please ensure it is under 6’ long when packed)*

We use single action reels only. Do you need another type? * (If yes, please ensure it is under 6’ long when packed) *

If Yes, what type of reel would you prefer

Emergency Contact Details

Emergency Contact Person *

Emergency Contact Primary Telephone *

Emergency Contact Relationship *