Tour Peru Registration Form

Jazz Peru Internacional tours@jazzperu.org

WELCOME! Thank you for joining the Gabriel Alegría Afro-Peruvian Sextet. In order to help us prepare for your arrival, we kindly request that you fill out the following one-page information form and mail it along with your $750 deposit (made out to The Afro-Peruvian Foundation for the Arts) to the address provided. We love you, but we cannot secure your reservation without your deposit. PERSONAL INFORMATION: Full name (as on passport):_______________________________________________________________ Address:______________________________City:_____________________State:_______Zip:________ Home Phone:__________________________Work Phone:_____________________________________ Email:________________________________Fax:____________________________________________ Date of birth:__________________________ Place of Birth:____________________________________ Passport Number:_______________________Expiration Date:__________________________________ (passport must not expire for a minimum of six months after entry to Peru) Citizenship:___________________________ Occupation:____________________________________ Do you have special dietary needs or health problems that require special assistance? Yes No Please describe:________________________________________________________________________ Please name preferred roommate:__________________________________________________________ How did you first hear about Tour Peru?____________________________________________________ EMERGENCY CONTACT: Name:_______________________________________________________________________________ Relationship: _________________________________________________________________________ Home Phone:___________________________Work Phone:____________________________________

Tour Peru Registration Form

Jazz Peru Internacional tours@jazzperu.org

We ask that you kindly send us a copy of your current and valid passport. If yours is not yet available, don’t worry. Send in the form now and we can update your passport when it becomes available. Please make out your check to

THE AFRO-PERUVIAN FOUNDATION FOR THE ARTS. Our mailing address: Afro-Peruvian Foundation for the Arts c/o Gabriel Alegría Tour Perú 2004 Mermaid Av. Suite 2F Brooklyn, NY 11224 USA As always, feel free to contact us at tours@jazzperu.org with any questions you might have. If you need to talk to someone, call Gabriel directly @ 213-200-1420!