reservations

A CLICK AWAY FROM PERU

To register for a Pica Peru Culinary Vacation, please complete the electronic registration form below. Once you complete the form and accept Pica Peru’s Terms & Conditions, you will need to pay the initial $500 trip deposit. You choose your payment option below, and you have two options—Pay by Check or Pay by PayPal. Once you click the payment button, you will be taken to a window with the information to help you complete your purchase. The remaining cost of your trip must be paid 60 days prior to the trip departure.

	Register
	Name and Destination of Vacation * Select Destination LIMA - MANCORA LIMA - SACRED VALLEY & CUSCO ............................................................................................................................................................................. Date of Vacation * Select Date of Vacation ............................................................................................................................................................................. Date of Arrival in Peru (MM/DD/YY) ............................................................................................................................................................................. Total Trip Cost (including single supplement) * Select Trip Cost ............................................................................................................................................................................. Date payment was sent, if paying by check * (MM/DD/YY) ............................................................................................................................................................................. Traveler(s) name(s) * ............................................................................................................................................................................. Address * ............................................................................................................................................................................. City * ............................................................................................................................................................................. State * Select State Not in the United States Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ............................................................................................................................................................................. Zip code * ............................................................................................................................................................................. Telephone * ............................................................................................................................................................................. Cell phone ............................................................................................................................................................................. Fax ............................................................................................................................................................................. E-mail * ............................................................................................................................................................................. Passport number(s) * ............................................................................................................................................................................. If you will be arriving in Lima prior to trip departure, please provide hotel and contact information ............................................................................................................................................................................. Emergency contact * ............................................................................................................................................................................. Emergency contact telephone * ............................................................................................................................................................................. Medical conditions, food allergies, or food restrictions * ............................................................................................................................................................................. Profession(s) of traveler(s) ............................................................................................................................................................................. Birthday(s) of traveler(s) (MM/DD/YY) ............................................................................................................................................................................. Do you speak Spanish? Yes No ............................................................................................................................................................................. Fluency level? Select Level Basic Intermediate Advanced .............................................................................................................................................................................  I have signed up for the Lima-Mancora trip, and I am interested in receiving additional information about trip bookings to Cusco and Machu Picchu .............................................................................................................................................................................  I am interested in arranging pre- and post-Pica Peru travel and would like to set up a time to talk about possible itineraries ............................................................................................................................................................................. How did you hear about Pica Peru Culinary Vacations? Internet Flyers Friend Others      ............................................................................................................................................................................. If you found Pica Peru through an internet search, which keyword did you use? .............................................................................................................................................................................   (*) Required fields I, and all trip participants included on this form accept Pica Peru's Terms & Conditions.                   Pay by Check:             Pay by: