Registration Form

Thank you for trusting Steve De Medeiros with your booking! Please NOTE this form does NOT confirm your travel, we will take this information and send you a separate confirmation once booked.

Kindly ensure that the names you are providing for yourself are the legal names as per your passports. Please note that misspelled or incorrect names could cause denial of boarding!

Please ensure your middle name entered above exactly matches your passport. You may be denied boarding if it is not the same as your passport!
 
Example: if your passport says "Donna M. Smith", you would only enter the value of 'M' in the Middle name box above.
 
Example #2: If your passport says "Donna Margaret Smith", you would enter the value "Margaret" above. The value must be the exact same as your passport.

Billing Address

Email address is required in order to receive a copy of the terms and conditions
Email address is required in order to receive a copy of the credit card authorization

Passenger 2


Passenger 3 (if applicable)


Passenger 4 (if applicable)


Passenger 5 (if applicable)


Should you have more than 5 passengers travelling, please submit details in the additional information text box below

Please submit your credit card info below

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Your Travel Agent has requested that you approve a credit card charge later on this form. The fields below can be used to securely communicate a credit card to your travel agent. You may skip this step, if you do not wish to communicate a credit card to your travel agent. 
 
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Emergency Contact Info (Optional)

Your booking is non refundable and no changes are permitted unless otherwise stated

We strongly recommend the purchase of Travel Insurance. Would you like a quote on Travel Insurance? *