2017 Sternberg Museum Outbound Galapagos


Galapagos Islands and Ecuadorian Cloud Forest

  • June 3rd – 14th , 2017
  • 10 days total, $5,000 per person; $1,000 due at registration
  • All participants must be age 21 or older at the time of the trip.
  • Trip cost includes hotels, guides, most meals, and transport on the Galapagos Islands and the cloud forests. Trip cost excludes cost of airfare to and from Quito, Ecuador. June 3rd and 14th are travel days; Activities in Ecuador and the Galapagos islands start early in the morning on June 4th.

Reserve your place: (6 spots remaining)

@ $1,000 each deposit; remainder due when 8 participants have registered


Participant information:

First Name
Last Name
Gender
Address
City
State
Zip
Email
Verify Email
Home Phone
Cell Phone
Work Phone

Emergency Contact Name
Emergency Home Phone
Emergency Cell Phone
Emergency Work Phone

Where did you hear about Sternberg Museum Outbound?

Please describe any medical or physical restrictions that could affect the participant's involvement in camp activities?
Please describe any special accomodations necessary to assist the student participate in camp activities and programs.
List any/all medications, what time(s) they are taken and for what reason/condition.
List any allergies the participant has (food, animals, plants, medications, etc).
Describe any participant dietary restrictions or considerations (vegetarian, vegan, etc.)

Do you suffer from Motion Sickness?
Do you carry an EpiPen or any other emergency medication?
Are you traveling alone?
If you are traveling alone, would you room with another solo traveler?
First Name
Last Name
Gender
Address
City
State
Zip
Email
Verify Email
Home Phone
Cell Phone
Work Phone

Emergency Contact Name
Emergency Home Phone
Emergency Cell Phone
Emergency Work Phone

Where did you hear about Sternberg Museum Outbound?

Please describe any medical or physical restrictions that could affect the participant's involvement in camp activities?
Please describe any special accomodations necessary to assist the student participate in camp activities and programs.
List any/all medications, what time(s) they are taken and for what reason/condition.
List any allergies the participant has (food, animals, plants, medications, etc).
Describe any participant dietary restrictions or considerations (vegetarian, vegan, etc.)

Do you suffer from Motion Sickness?
Do you carry an EpiPen or any other emergency medication?
Are you traveling alone?
If you are traveling alone, would you room with another solo traveler?
First Name
Last Name
Gender
Address
City
State
Zip
Email
Verify Email
Home Phone
Cell Phone
Work Phone

Emergency Contact Name
Emergency Home Phone
Emergency Cell Phone
Emergency Work Phone

Where did you hear about Sternberg Museum Outbound?

Please describe any medical or physical restrictions that could affect the participant's involvement in camp activities?
Please describe any special accomodations necessary to assist the student participate in camp activities and programs.
List any/all medications, what time(s) they are taken and for what reason/condition.
List any allergies the participant has (food, animals, plants, medications, etc).
Describe any participant dietary restrictions or considerations (vegetarian, vegan, etc.)

Do you suffer from Motion Sickness?
Do you carry an EpiPen or any other emergency medication?
Are you traveling alone?
If you are traveling alone, would you room with another solo traveler?
First Name
Last Name
Gender
Address
City
State
Zip
Email
Verify Email
Home Phone
Cell Phone
Work Phone

Emergency Contact Name
Emergency Home Phone
Emergency Cell Phone
Emergency Work Phone

Where did you hear about Sternberg Museum Outbound?

Please describe any medical or physical restrictions that could affect the participant's involvement in camp activities?
Please describe any special accomodations necessary to assist the student participate in camp activities and programs.
List any/all medications, what time(s) they are taken and for what reason/condition.
List any allergies the participant has (food, animals, plants, medications, etc).
Describe any participant dietary restrictions or considerations (vegetarian, vegan, etc.)

Do you suffer from Motion Sickness?
Do you carry an EpiPen or any other emergency medication?
Are you traveling alone?
If you are traveling alone, would you room with another solo traveler?

By checking this box, I agree and understand that the $5,000 fee for this trip excludes the cost of my airfare to, and back from, Quito, Ecuador. I will arrange my own flight to Quito, Ecuador to arrive on June 3rd, where I will meet the group at a hotel near the airport. I will arrange my own flight departure from Quito for June 14th, unless otherwise arranged with the Sternberg Museum trip leaders.
By checking this box, I understand the following dates for refunds of the trip fee: Before December 1st, 100% refund on cancellations; after December 1st, only 70% of the fee is refundable. After March 1st, only 50% of the trip fee is refundable. After April 1st, the fee becomes non-refundable.
By checking this box, I understand that The Centers for Disease Control advises travelers to make sure they are up-to-date on routine vaccines before entering Ecuador and the Galapagos. These vaccines include measles-mumps-rubella (MMR), diphtheria-tetanus-pertussis, varicella (chickenpox), polio, and your yearly flu shot.

Amount to be charged: $ 1000 deposit; remainder due when 8 participants have registered
© 2017 Sternberg Museum of Natural History, Fort Hays State University