Please fill out this form completely. All basic information is required.
Name:*
Address:*
Phone Number:*
Email:*
Arrival and Departure Dates:
Which Lodges do you plan to visit?
Which Hotels do you plan to visit and on what dates?
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
IMPORTANT! Passport information Every guest most forward us a photo or scan of their current passport. The easiest way to get that to us is taking a photo with your cell phone and then emailing it to jcampa@flyfishingpatagonia.com or texting it to 434-249-1783
Special interests or additional comments to help us insure your comfort and satisfaction:
How did you hear about us? Referred by whom?
