Morocco 2024 Registration Page 1 of 3 Please complete the following form to reserve your spot! Participant Information Name * First Name Last Name Date of Birth * MM DD YYYY Email * Phone * Country (###) ### #### Gender * Male Female Do you hold a US Passport? * Yes No Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency Contact Name * First Name Last Name Email * Phone * Country (###) ### #### Relationship to you * Parent Parent Sibling Spouse Child Relative Legal Guardian Friend Co-worker Partner Roommate Other Travel Preferences Have you traveled to Morocco before? * Yes No Will you be a solo traveler? * Yes No If no, please list the names of other travelers coming with you Room accommodation requests? * Double Occupancy Room Triple Occupancy Room No Prefrence Please confirm the following details I understand the trip dates are May 18th to May 25th 2024? * Yes No I understand my program cost does NOT include airfare? * Yes No Legal Notice I hereby acknowledge the risks involved in participating in the Mozaic Retreat to Morocco and voluntarily assume all risks related to my participation. I agree to release and hold harmless Mozaic, its employees, agents, and partners from any claims, damages, or injuries incurred during the retreat. I confirm that I have adequate medical insurance for the duration of the retreat and agree to comply with local laws and customs. I agree I do not agree Thank you! Someone from our travel team will reach out to you shortly.
