Cuba Travel Registration Form

IMPORTANT: A separate registration form is required for each traveler. If there are several travelers in your group please be sure that a registration form is submitted separately for each traveler.

Cuba Educational Experiences Registration Form

Space is very limited and priority is given to early registrants. We look forward to your participation in this unique and enriching program!

CONTACT INFORMATION
Your privacy is a priority. We'll never share your information or send you spam. See our privacy policy at: https://oceandoctor.org/privacy
Name*
First Last
Email*
Enter Email Confirm Email
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Preferred Airport for Departure/Return (Enter code and/or name)*

U.S.-based travelers will rendezvous at Miami International Airport and travel as a group via American Airlines to Havana. Our travel provider, Marazul Charters, will work with you directly to book & coordinate your flights.
Phone*
Note: Please enter using format: (###)###-####
Please Select a Trip*
- June 1-11: Isle of Youth, Bay of Pigs, Trinidad, Havana
- Nov 9-19: Isle of Youth, Bay of Pigs, Trinidad, Havana
Others Traveling With You
Other Travelers Accompanying You (if Applicable)
IMPORTANT: A separate registration form is required for each traveler. If there are several travelers in your group please be sure that each one submits this form.
Name of Preferred Roommate (if Applicable)

Enter "Solo" if you wish to room alone. A single supplement charge will apply.
Emergency Contact
Emergency Contact Name*
Emergency Contact Phone*
Note: Please enter using format: (###)###-####
Emergency Contact Email*
Enter Email Confirm Email
Passport Information
Date of Birth*
MM slash DD slash YYYY
Country of Birth*
Country
Country of Residency*
Country
Passport Number*
Passport Country*
Country
Date of Issue*
MM slash DD slash YYYY
Date of Expiration*
MM slash DD slash YYYY
Health Information
Please List Any Medical Conditions/Restrictions We Should Be Aware Of, If Any
Please List Any Allergies (Food, Drink, Insects, etc.), if Any
Please List Any Dietary Restrictions (Vegetarian, Vegan, etc.), if Any
Other
I Am a Certified Scuba Diver*
- Yes
- No
Special Requests, Questions & Comments (Optional)
Agreement*
- I understand that submitting my registration information does not guarantee a confirmed reservation and that my reservation will be confirmed in writing/email by Ocean Doctor. I/We agree to hold Ocean Doctor and its travel service providers harmless should it not be possible to honor my/our travel request and/or preferences.
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Cuba Travel Registration Form

Cuba Travel Registration Form

Cuba Educational Experiences Registration Form

CONTACT INFORMATION

Others Traveling With You

Emergency Contact

Passport Information

Health Information

Other