Booking – ModTour

1. Personal data

First Name

Last Name

Date of birth

Nationality

Passport number

Passport validity

2. Contact details

Address Line 1

City

State

Country

Phone/Mobile

3. Medical Information

Do you have any health issues that we should know about?

Are you taking any medications?

Ja (India ja, light toe)

4. Noodcontact

What medication are you taking?

Name of emergency contact person

Emergency Contact Number

Relationship to you

5. Preferences and Comments

Special dietary requirements/allergies:

Roommate preference (if applicable) :

Would you like to book a single room? (Please note: there is a surcharge of €400 for this)

Yes

6. Experiences and references

Where did you hear about us? (select an option) :

Instagram

Facebook

Through friends/family

Google

Have you traveled with a group before?

Yes

If yes, please explain: with which organization and your experience

7. Payment

Payment method

Transfer

Other

Payment method Other

Deposit (€500 required upon registration)

8. Upload documents

Copy of passport (valid until at least October 2025) Upload 1 supported file: PDF, document, or image. Max 100 MB.

Choose File

Proof of travel insurance (with medical coverage) Upload 1 supported file: PDF, document, or image. Max 100 MB.

Choose File

9. Declaration of consent

I declare that I have read and accept the program and travel conditions.

Thank you for your registration! We will contact you soon to confirm your registration. Do you have any questions? Send us an email at info@nextleveldiscovery.be .

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