Tuscany Registration Stage 2 In order to complete your registration, we just need a little more information. Please scroll down and fill out the form so we can learn more about you: If you have trouble with this form or have additional questions, you can contact Laura by email at email@example.com or 1-800-611-5144 (toll free in the US and Canada). Tuscany Registration Form Personal InformationFirst Name*Last Name*Best method and best time to contact you (if it’s by phone, include your time zone):*Passport InformationIn the spaces below, enter your name exactly as it appears on your passport, as well as your passport number, the country that issued the passport, and the expiration date. (Your passport needs to be valid for six months beyond the time of our trip). If you’re in process of renewing your passport, just tell us in the box below!Your Passport First Name(s)*Your Passport Surname(s)*Passport Number*Passport Expiration Date*Country That Issued Your Passport*If you are in the process of renewing your passport, please give details below:AccommodationsIf you have chosen a double-occupancy room, do you have a roommate in mind, or do you want us to try to pair you up with someone?*Learning About YouSpecifically, how did you learn about this trip?*What attracted you to this particular travel adventure with Laura, Graseilah and Karen? Why this trip? Why Tuscany?*What are your expectations of this trip?*What do you hope to gain from this trip?*Learning More About YouWhat's Your Birthdate?Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Your Occupation?*Your Hobbies and Interests?*Describe your previous travel experience. Let us know if you’ve been to Italy before.*Describe your relationship with writing, mindfulness and yoga. (It’s fine to be a beginner at any or all of them).*Health, Fitness and DietAre you a smoker?*Do you have any dietary needs, restrictions, or allergies we should be aware of? Yes Please describe.Please describe your health, noting any allergies or conditions you have, or medication you take, as well as anything else we should be aware of that might impact your participation in this trip.*Do you have any special needs?* Yes No Please describe those needs.Are you currently under the supervision of a doctor?* Yes No Please explain why you are currently under doctor supervision.Do you have a history of mental illness?* Yes No Please explain your history. I understand that if I am vegan or gluten free, there will be limited food options on the trail and I may need to bring food from home to supplement what’s available. Emergency ContactIn case of emergency, who should we contact? Include their name, their relationship to you, phone number(s), and email address.*TravelWould you like to work with our travel agent to arrange your transportation to and from Italy and/or to help purchase travel insurance?* Yes please. No thank you. Travel InsuranceMedical coverage, evacuation and trip cancellation insurance are required for this trip.*I understand that I am making a non-refundable deposit and that the remaining payments I make for this trip are refundable only on a graduated basis. Trip cancellation insurance is required and necessary to protect my investment. I understand. I will choose and purchase travel insurance within two weeks of registering for this trip. Important!We want to be sure you have a chosen a trip that meets your expectations.* I have read the itinerary and physical requirements for this trip and am happy I will be able to participate fully. CommentsThis field is for validation purposes and should be left unchanged.