Vermilion Sea Institute · ADITO Secondary VSI Registration 2023

Contact Information

Name

*

First Name

Last Name

Preferred pronouns

Date of Birth

*

(mm/dd/yyyy)

Email

*

Verify Email

*

Phone

*

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

COVID-19 Vaccination/Test

*

VSI requires all trip participants in 2023 to be fully vaccinated or provide proof of a negative COVID-19 test within 72 hours of the trip’s first day. Please let us know if you plan show proof of vaccination or a negative test when you meet your trip leaders.

Cancel for Any Reason Trip Protection

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If you would like to protect your trip payment with "Cancel for Any Reason Trip Protection," it allows you to cancel any time prior to Day 1 and receive a full refund. Please note, this is not medical evacuation coverage and does not cover payments made to outside companies (airlines, hotels, etc.). This protection covers registration payments to ADITO (excluding previously submitted deposits). Cost of trip protection is $100. If you decide to decline to purchase trip protection, please understand that you will not be refunded any portion of your payment should you need to cancel.

I would like to protect my trip payment with "Cancel for Any Reason Trip Protection."

I decline to purchase trip protection and understand that I will not be refunded any portion of my payment should I need to cancel.

Dietary Committment

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To have the appropriate quantities and reduce food waste, please take this opportunity to let us know which items you'll never eat.

No Fish

No Chicken

No Pork

No Beef

No Dairy

No Eggs

No Gluten

Other (add detail below)

No Dietary Restrictions

Dietary Restrictions

Please describe, in detail, any dietary restrictions not represented above. Please include the severity of the dietary sensitivity.

Allergy/Medical Information

*

Please describe any medical conditions or medications for this participant. Please Note that Vermilion Sea Institute (VSI) requests this information to assist staff in the management of courses and in the emergency response of medical conditions that any participant or observer may have. This information will remain protected and confidential. By requesting this information, VSI does not imply that we have the expertise to assess your physical condition or your ability to participate in this course. This determination of ability must be made by you, the participant, in concert with your physician.

Name of Emergency Contact (Not traveling with you)

*

First Name

Last Name

Relation of Emergency Contact

*

Phone Number for Emergency Contact

*

Email for Emergency Contact

*

Verify Email

*

Medical Evacuation Trip Insurance Provider AND Policy Number

*

You are required to purchase third-party medical evacuation trip insurance. This is not your typical medical insurance. Insuremytrip.com is a good place to start comparing rates. You may wish to wait to register until you have explored your options for a combined cancellation/medical evacuation insurance. If not yet purchased, please indicate date you will intend to purchase.

Medical Evacuation Trip Insurance Emergency Phone Number

*

Passport Number

*

Passport Issue Date

*

(mm/dd/yyyy)

Passport Expiration Date

*

(mm/dd/yyyy)

Would you like to receive the Vermilion Sea Institute Newsletter via email?

*

Select "Yes" to receive updates about our work and invitations to upcoming events.