First Name	Last Name
Email address	Country/ State
Date of Birth	Phone(extension)
/ /
Address
Language(s) you speak	No. of people in your party
Names/age
Preferred travel dates
/ /  to  / /
Length of trip with us
3 days   5 days   7 days   10 days   Other
Sports adventure interested
Rock climbing / grade  Trekking / level  hard  medium  easy Rafting / Class  II  III  IV  V Skydiving Paragliding Cascading Other(s)
Which sports adventure do you want to start with?
1.   4.   7. 2.   5.   8. 3.   6.   9.
Which states would you like to begin with? 1 to 5
Rio Grande do Sul   Santa Catarinha   Paraná São Paulo   Rio de Janeiro
Would you like airfare included?   Yes    No
Would you like rental car included?   Yes    No
Where would you like to stay?
Hotel    2 stars    3 stars    4 stars    5 stars    Inn Camping Other No accommodations needed
Breakfast included   Yes    No
All meals included  Yes    No
What city sights are you interested in during your trip? (If you have a preference, please specify)
Bars Restaurants Clubs Museums City tourist points Parks Shows Others
How would like to fulfill your trip?
Everyday adventure sports activities Everyday adventure sports activities and city sights at night Adventure sports activities in mornings and city sights in afternoons Sport adventures activities + free time City sights + free time Adventure sports activities + city sight + free time Other
What kind of equipment/accessories will you bring with you?
None Sleeping Bags Rock climbing shoes Trekking boots Neoprene suits Cooking accessories (msr, plates, etc.) Other
Do you have travel insurance?
Yes, Provider    No
Please state any other special needs and/or requests that you have
We will be in touch with you very soon, thanks for your info.