Animal Balance · Galápagos Trip Signup Form

Galápagos Trip Signup Form

Welcome to the application to join us on the

Galápagos Island Tour: Solutions for Species Conflict Like No Other

The agency for the protection of the biodiversity of the Islands and Animal Balance invite you to join us for an inside look at the work being carried out to protect the archipelago, while enjoying the sights, sounds, and spectacular beauty of the Galápagos Islands!

Contact Information

Name

First Name

Last Name

Occupation/Organization and Position/Title

Phone

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Languages Spoken

Have you volunteered on campaign with AB in the past either domestic or international?

Yes - domestic

Yes - international

Yes - both domestic and international

Preferred Travel Availability

Are you fully vaccinated against COVID-19?

SPECIAL, ADDITIONAL ENTRY REQUIREMENTS FOR THE GALAPAGOS ISLANDS – Beginning February 9, 2022, to enter the Galapagos Islands, the traveler must present: A COVID-19 vaccination card with QR code or a COVID-19 vaccination certificate showing the traveler received a complete series of the COVID-19 vaccine at least 14 days prior to entering Galapagos, or proof of a negative COVID-19 RT-PCR test taken no more than 72 hours prior to boarding the flight to Galapagos, and A “transit control card” issued by the Government of Galapagos.  Contact your tour operator for more information on this requirement.

Yes

Partially - please explain in notes

I'm not fully vaccinated but...

Are you over 18?

Yes

Date Of Birth

(mm/dd/yyyy)

Health and Physical Fitness

Do you suffer from any illness, including but not limited to asthma, epilepsy, diabetes, allergies? Do you take any prescription drugs or over-the-counter medicines? Have you had any psychological / psychiatric illness in the last three years? If yes to any of the above, please supply more info in the box. If no, Enter N/A. *

Do you have health insurance?

Yes

Do you have any dietary restrictions?

Yes*

If you chose YES please explain here.

Please Tell Us About You

We'd like to get to know you!

How did you hear about us?

Please check this box if you want to join Animal Balance's trip-specific mailing list

Join Animal Balance's Galápagos Islands Trip Email List