Online Registration Please complete this registration form to reserve your place on an Explore Guatemala Art Workshop or one of our Tours. Upon receipt of this form, we will provide additional information to assist you in planning your trip. Do not make airline or travel insurance arrangements until you are informed by Explore Guatemala that your Workshop or Tour has “made.” * This program features a fair amount of walking, often in villages where there are uneven or cobblestone streets (some with steep inclines). If you have trouble walking or are wheel-chair bound, please reconsider your participation. Note: All fields below are required. After submission of this form, please submit your registration payment here. Name of Art Workshop or Tour ---Terry Gay Puckett (Jan 11 - 21, 2016)Jan Ledbetter (March 17 - 27, 2016) First Passenger Second Passenger Name exactly as it appears on your passport Name you go by Passport Number (Current Passport Required) Nationality Address with City, State and Zip Primary Telephone Number Other Telephone Numbers Email Address Sex (M/F) MF MF Date of Birth Occupation Medical/Dietary Considerations Emergency Contact Name Emergency Contact Phone I am on my own but wish to share a roomI am a smokerI prefer the single supplement chargeI wish to participate in the Optional Add-on associated with this trip. By submitting this form, I certify that I understand and accept the policies as explained in the Company’s " Terms and Conditions. Note: All fields are required. After submission of this form, please submit your registration payment here.