Booking ID Traveller Details *Full Name Unique Identification Number (If Applicable) *Date of Birth *Nationality -Select Country- Afghanistan Albania Algeria Andorra Angola Anguilla Antigua & Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia & Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China China - Hong Kong / Macau Colombia Comoros Congo Congo, Democratic Republic of (DRC) Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France French Guiana Gabon Gambia Georgia Germany Ghana Great Britain Greece Grenada Guadeloupe Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Israel and the Occupied Territories Italy Ivory Coast (Cote d'Ivoire) Jamaica Japan Jordan Kazakhstan Kenya Korea, Democratic Republic of (North Korea) Korea, Republic of (South Korea) Kosovo Kuwait Kyrgyz Republic (Kyrgyzstan) Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia, Republic of Madagascar Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mayotte Mexico Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar/Burma Namibia Nepal New Zealand Nicaragua Niger Nigeria Norway Oman Pacific Islands Pakistan Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovak Republic (Slovakia) Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Tajikistan Tanzania Thailand Netherlands Timor Leste Togo Trinidad & Tobago Tunisia Turkey Turkmenistan Turks & Caicos Islands Uganda Ukraine United Arab Emirates United Kingdom (UK) United States of America (USA) Uruguay Uzbekistan Venezuela Vietnam Virgin Islands (UK) Virgin Islands (US) Yemen Zambia Zimbabwe *Gender: Male Female Other *Meal preference: Vegetarian Non-Vegetarian Gluten Free Vegan Other Please mention other meal preference (If Any) Address *Address line 1 Address line 2 *City State *Postal/Zip Code *Country -Select Country- Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Austrian Empire Azerbaijan Baden* Bahrain Bangladesh Barbados Bavaria* Belarus Belgium Belize Benin (Dahomey) Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Brunswick and Lüneburg Bulgaria Burkina Faso (Upper Volta) Burma Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Central American Federation* Chad Chile China Colombia Comoros Costa Rica Cote d’Ivoire (Ivory Coast) Croatia Cuba Cyprus Czechia Czechoslovakia Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Germany (German Democratic Republic) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Federal Government of Germany (1848-49)* Fiji Finland France Gabon Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Hanover* Hanseatic Republics* Hawaii* Hesse* Holy See Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kingdom of Serbia/Yugoslavia* Kiribati Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Lew Chew (Loochoo)* Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mecklenburg-Schwerin* Mecklenburg-Strelitz* Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nassau* Nauru Nepal New Zealand Nicaragua Niger Nigeria North German Confederation* North German Union* Norway Oldenburg* Oman Orange Free State* Pakistan Palau Panama Papal States* Papua New Guinea Paraguay Peru Philippines Piedmont-Sardinia* Poland Portugal Qatar Republic of Genoa* Republic of Korea (South Korea) Republic of the Congo Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Schaumburg-Lippe* Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syria Tajikistan Tanzania Texas* Thailand The Bahamas The Cayman Islands The Congo Free State The Duchy of Parma* The Gambia The Grand Duchy of Tuscany* The Netherlands The Solomon Islands The United Arab Emirates The United Kingdom Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Two Sicilies* Uganda Ukraine Union of Soviet Socialist Republics* Uruguay Uzbekistan Vanuatu Venezuela Vietnam Württemberg* Yemen Zambia Zimbabwe Contact Details *Primary Contact Number Alternate Contact Number *Primary Email Alternate Email Emergency Contact Details *Full Name *Relationship with traveller -Select Relationship- Brother Father Guardian Mother Sister Spouse Other *Address line 1 Address line 2 *City State *Postal/Zip Code *Country -Select Country- Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Austrian Empire Azerbaijan Baden* Bahrain Bangladesh Barbados Bavaria* Belarus Belgium Belize Benin (Dahomey) Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Brunswick and Lüneburg Bulgaria Burkina Faso (Upper Volta) Burma Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Central American Federation* Chad Chile China Colombia Comoros Costa Rica Cote d’Ivoire (Ivory Coast) Croatia Cuba Cyprus Czechia Czechoslovakia Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Germany (German Democratic Republic) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Federal Government of Germany (1848-49)* Fiji Finland France Gabon Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Hanover* Hanseatic Republics* Hawaii* Hesse* Holy See Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kingdom of Serbia/Yugoslavia* Kiribati Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Lew Chew (Loochoo)* Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mecklenburg-Schwerin* Mecklenburg-Strelitz* Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nassau* Nauru Nepal New Zealand Nicaragua Niger Nigeria North German Confederation* North German Union* Norway Oldenburg* Oman Orange Free State* Pakistan Palau Panama Papal States* Papua New Guinea Paraguay Peru Philippines Piedmont-Sardinia* Poland Portugal Qatar Republic of Genoa* Republic of Korea (South Korea) Republic of the Congo Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Schaumburg-Lippe* Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syria Tajikistan Tanzania Texas* Thailand The Bahamas The Cayman Islands The Congo Free State The Duchy of Parma* The Gambia The Grand Duchy of Tuscany* The Netherlands The Solomon Islands The United Arab Emirates The United Kingdom Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Two Sicilies* Uganda Ukraine Union of Soviet Socialist Republics* Uruguay Uzbekistan Vanuatu Venezuela Vietnam Württemberg* Yemen Zambia Zimbabwe *Primary Contact Number Alternate Contact Number *Primary Email Alternate Email Passport Details *Passport number *Place of issue *Date of Issue *Date of Expiry Medical Details *Blood group - Select Blood Group - A+ A- AB+ AB- B+ B- O+ O- *Do you suffer from Motion Sickness? Yes No *Do you suffer from Sleep Walking? Yes No *Do you suffer from Asthma? Yes No If yes, please upload a detailed history, with the medicines and clearance from the doctor that you are fit to participate in the program. *Do you suffer from Epilepsy? Yes No If yes, please upload a detailed history, with the medicines and clearance from the doctor that you are fit to participate in the program. *Do you suffer from Heart Disease? Yes No If yes, please upload a detailed history, with the medicines and clearance from the doctor that you are fit to participate in the program. *Have you had any bone/muscle injury or fracture in the past 6 months? Yes No If yes, please specify. *Are you allergic to any thing? Yes No If yes, please specify. *Are you taking any other form of medication? Yes No If yes, please specify. Upload Files Upload documents for all detailed medical history, if required. File(s) size limit is 20MB. Please attach the relevant medical certificate and a clearance from the doctor deeming you fit for the program. You can click on the upload tab at the end of the ‘page to attach the documents. PLEASE NOTE: Edspera reserves the right to refuse participation if not satisfied with the medical case history. I hereby confirm that all information provided here is accurate and complete to the best of my knowledge. I have fully read and understood all the terms and conditions.