Multi-Day Trip Questionnaire

Your Email (required)

First Name (required)

Last Name (required)

Mailing Address (required)

City (required)

State (required)

Zip Code (required)

Country (required)

Home Phone (required)

Work Phone

Select Your Trip (required)

Kayak Camping Trips
---2 Day Shoup Glacier3 Day Shoup Glacier3 Day Columbia to Glacier Island Camp4 Day Glacier Island to Columbia Glacier6 Day Shoup Glacier to Glacier Island Classic Camp8 Day Remote Glaciers and Bays CampCustom Tour (enter price if known)

Multi-sport Tours
---8 Day Alaskan Sampler Multi-sport11 Day Sea and Sky Multi-sport6 Day Shoup Glacier Pack and Paddle12 Day Ultimate WildernessCustom Multi-sport (enter price if known)

Mothership and Wilderness Lodge-Based Tours
---4 Day Sampler Cruise6 Day Classic Explorer6 Day PWS Glaciers and Bays8 Day Whales and Ice CruiseCustom Sailing3 Day Prince William Sound LodgeCustom PWS Lodge (enter price if known)

Backpacking Tours
---4 Day Shoup Bay to Anderson Glacier4 Day Valdez Glacier to Miners Footsteps5 Day Donoho Wilderness5 Day Iceberg Lake Basecamp6 Day Skolai to WolverineCustom Tour (enter price if known)

Select Tour Start Date (required)
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Date of Birth (required)
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Height

Weight (in lbs)

Foot Size (specify Men's or Women's)

Occupation

EMERGENCY CONTACT INFO

Name

Contact Address

City

State

Zip

Phone

Please leave this field empty.

OTHER INFORMATION

How will you get to Valdez if trip originates in Valdez?
---Flying from AnchorageDrivingFerryOther

Would you like for us to pick you up at the Valdez Airport or Ferry?
NoYes (please enter arrival time below)

Arrival Time

Please list any previous kayak or backpacking experience.

Have you been on a trip with Pangaea?

Estimate of physical condition (this will be important for us to design the best itinerary for your enjoyment):
ExcellentGoodFairPoor

Describe any regular, physical activity:

Physical Limitations: This is the most important question to answer. Please list injuries, medical needs, allergies, back problems, sea sickness, etc... We can work around limitations if we know about them. This will help the safety of you and the group.

Diabetic
Shoulder Injuries or Arm Pain
Heart Condition
Back Pain
Asthma
Allergies
Other: Please explain in box below.

Please give us some of your expectations regarding this trip.

FOOD PREFERENCES

No preference? Select this option.
I'll eat anything and be happy!.

Select all you prefer.
Spicy Foods
Plain Foods
Low Fat Foods
Heavy or Creamy Foods
Vegetarian
Fish OK
Chicken OK
Red Meat OK
Actually, lot's of red meat!!
No Dairy
No Wheat
Low Sodium

Do you drink coffee?

Yes
No
Regular
Decaf

Please specify any limitations:

Favorite, non-alcoholic beverage:

Favorite food dish:

Least favorite foods:

Equipment needed (optional at no extra charge):

Sleeping Bag
Sleeping Pad
No gear needed, I have my own.

Other comments or concerns:

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