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Colombia : Coffee, Culture & Community Tour 2025 Application

Welcome to our application form, we are excited to go on this journey with you! The estimated time to complete this form is 15 minutes.

Participant information

Passport and Travel Information

Birthday
Gender listed on your passport (required by international travel)
Male (M)
Female (F)
Another gender identity (X)

Lodging and Roommate information

We will stay in 5-6 different lodgings during the trip. About half the time, we may be staying in rooms that sleep four people per room. If you are traveling with a friend or colleague and wish to room together, you can enter their name now. There are a limited number of single rooms available during our trip for an additional cost. Please contact carrie.pilmer@gmail.com if you may be interested in this option.

Medical Form and Dietary Information

Your information is confidential and will be shared only with those who need to know in order to assist you while traveling, including, for example, providing emergency or other necessary care. We recommend you discuss any specific concerns with your doctor. No vaccinations are required for this trip, although the yellow fever vaccine is recommended in other parts of Colombia.


Participants must meet the following general requirements: possess the physical and mental well-being required to travel abroad where resources may be different or fewer than those to which you are accustomed; exercise good judgment; demonstrate flexibility and function in the face of potentially uncertain or stressful situations. You may experience new environmental allergies or experience seasonal allergies at a time of year when you normally do not encounter issues. We recommend you bring all medication and/or inhalers as prescribed. One of the Trip Leaders may contact you prior to the trip to determine how we can best meet your medical needs while in Colombia.


Participants will engage in activities including, but not limited to:

o City walking

o Walking on uneven surfaces, dirt roads, and/or light hiking 

o Local travel over rough roads

o Carrying own bags

o Climbing stairs

o Standing for extended periods

o Sitting on hard surfaces (e.g. wood, the ground) for extended periods

o Dancing


Depending on the trip’s itinerary or environmental situation, participants may also engage in activities including, but not limited to:

o Sleeping without fans

o Swimming in pools, rivers, waterfalls

Optional Disclosures

NOTICE OF PRIVACY PRACTICES

I certify to Tour Organization that the information provided is accurate. I authorize any physician, nurse or other health care provider to communicate with the Trip Leaders about my medical condition, treatment, and/or prognosis as needed. In the event I am unable to make such decisions, I hereby give permission to the physician selected by Tour Organization, and its representatives to order X-rays, routine tests and treatment for me, to secure proper treatment for, and in the event of an emergency, to order injections and/or anesthesia and/or surgery for me. I hereby give permission to 94 Pueblos to disclose any HIPAA and other healthcare information to these representatives as well as my emergency contacts if I am unable to do so myself.


I understand that I am responsible for any additional medical costs and related costs (medications, hospital bills, doctor visits, additional transportation and accommodations, etc.) related to sickness while on Program.


I certify that I have no physical conditions that affect my ability to travel and/or participate in any of the activities involved in this trip. I understand that I am responsible for notifying the Trip Leader immediately of any injury, sickness or other medical condition, or change to the medical information herein provided.

Note: This information below will be used for your meal orders in Colombia. If we have any questions on how to best meet your needs, we will reach out to you before or during the trip.

Dietary Preferences and Allergy Concerns (If none, select "None")

Dietary Preferences and Food Allergy Concerns

Illegal Drug and Alcohol Policies

I understand that the possession or use of illegal drugs at any time during this Program is prohibited. Therefore, I agree not to possess or use illegal drugs at any time during the Program. Possession or use of marijuana and CBD products is prohibited during the Program. I understand that the Tour Organization is in no way responsible for my actions, safety, or legal status if I refuse to abide by this agreement.

I understand that possession or use of alcohol during this Program is acceptable when used responsibly. I understand that the tour organization is in no way responsible for my actions, safety, or legal status if I refuse to abide by this agreement.

Payment Terms

The program cost is $2,950, due no later than April 30, 2025. Payment can be made via credit card, payment link, PayPal, or bank transfers. The deposit should be paid immediately after completing this form.


Costs Covered by Program

Program costs include the following expenses during the travel dates of the Program:

● All lodging in country

● All meals and water in country

● All transportation in country

● Event entrance fees and guide fees in country


The non-refundable deposit will be applied to the total cost of the program, which is $2,950 USD.

You will receive a bill after submitting the deposit and application form. Select the payment option that works best for you. Payment in full is required by April 30, 2025.

Tour Organization Personal Information Release Form

By signing this application form I authorize the Tour Organization to use the following personal information:

  1. My picture – including photographic, motion picture, and electronic (video) images.

  2. My voice – including sound and video recordings.

My signature below affirms I understand and agree to the policies laid out in this application and that I would like to participate in Colombia: Coffee, Culture, and Community.

Date

We will invoice you as soon as we have received the deposit and this application.

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