Use this form to check off your interests which will help us in some preliminary planning of the perfect trip for you.

First Name:
Last Name:
Your E-mail:
Company Name:
Street Address:
State/Province: Postal Code:
Home Phone#:
Work Phone#: ext.
Fax #:

Length of Stay:

Arrival Date:

Time of Arrival:

Departure Date:

Departure City:

Number in party and sleeping arrangements:

Special Requests or Comments:

Mainland Interests

Maya Ruins No Yes
Rainforest No Yes
Birding No Yes
Horseback Riding No Yes
Canoeing No Yes
Rock Climbing No Yes
Caving No Yes

Island Interests

Diving: No Yes
Beginner No Yes
Intermediate No Yes
Advanced No Yes
Blue Hole trip No Yes
Atoll trips (wall dives) No Yes
Mainland side trips: jungle river and Maya ruins by boat No Yes
I am aware of the fact that I need a passport to visit Belize No Yes

In the U.S.- Phone 1-800-451-7776, Fax 1-414-258-5336

In Belize- Phone 011-501-26-2822, Fax 011-501-26-3746
8715 West North Avenue, Wauwatosa, WI 53226 U.S.A.

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