(+55) 33 3277 9282

(+55) 33 8432 0832

Steve@XCBrazil.com

 

Online Booking Form

 Please complete as much detail as possible. If there is some information that is not available at this time, for example if you have not yet purchased your holiday insurance, just mark it as NYK. You can amend this by email at a later date.

All the information requested is for our records and your safety so please take the time to complete it accurately. When you have completed the form use the 'Submit' button at the bottom of the page.

Personal Details  
Name
Email address
Postal Address:
Telephone Number:
Mobile Number:
Date of Birth (dd/mm/yy):
Nationality:
   
   
Glider Details  
Make:
Model:
Glider Colour:
   
Insurance Details  
Company
Policy Number
Insurance Contact Tel Number:
   
Contact in Case of Emergency  
Name:
Postal Address:
Relationship:
Telephone:
   
Any medication you are currently taking:
Any Allergies:
   
Select Tour  
Tour date
   
Brief details of previous experience.
Any other Comments  
Any other comments you would like to make: