Guest Information Form

Name:*

Address:*

Phone Number:*

Email:*

Arrival and Departure Dates:

Which Lodges do you plan to visit?

Do you have any dietary restrictions or requests?

What beverages do you prefer? Please check all that apply: BeerRed WineWhite WineWhiskeyGinRumVodkaScotchCokeSpriteDietWaterRegular/herbal Tea

Are there any medical/physical conditions we should be aware of? Please explain in detail:

Person(s) to contact in case of emergency:
Name
Phone
Email

Name
Phone
Email

Please indicate if you need to rent fishing gear.

Rod and Reel: YesNo

Waders: YesNo

For waders, please give us your measurements:
Waist
Height
Weight
Shoe Size

IMPORTANT! Your Flight Information:
Please forward us your international and domestic flight confirmations that were/will be emailed to you via the airlines or agent. Please forward to jcampa@flyfishingpatagonia.com

Passport information for all guests:
Guest 1
Name on Passport:
Passport number:
Issue Date:
Expiration Date:
Nationality:
Date of Birth:

Guest 2
Name on Passport:
Passport number:
Issue Date:
Expiration Date:
Nationality:
Date of Birth:

Guest 3
Name on Passport:
Passport number:
Issue Date:
Expiration Date:
Nationality:
Date of Birth:

Guest 4
Name on Passport:
Passport number:
Issue Date:
Expiration Date:
Nationality:
Date of Birth:

Guest 5
Name on Passport:
Passport number:
Issue Date:
Expiration Date:
Nationality:
Date of Birth:

Guest 6
Name on Passport:
Passport number:
Issue Date:
Expiration Date:
Nationality:
Date of Birth:

Guest 7
Name on Passport:
Passport number:
Issue Date:
Expiration Date:
Nationality:
Date of Birth:

Guest 8
Name on Passport:
Passport number:
Issue Date:
Expiration Date:
Nationality:
Date of Birth:

Special interests or additional comments to help us insure your comfort and satisfaction:

How did you hear about us? Referred by whom?