Please provide us with your contact information belowName* Email* Phone*Country of OriginUnited KingdomUnited States of AmericaCanadaGermanyAlbaniaAmerican SamoaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBarbadosBelarusBelgiumBelizeBermudaBoliviaBosnia and HerzegovinaBrazilBulgariaCameroonCape VerdeChileChinaColombiaCosta RicaCroatiaCubaCyprusCzech RepublicDenmarkDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGhanaGreeceGreenlandGrenadaGuamGuatemalaGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Information about your stay in Costa RicaArrival Date* MM slash DD slash YYYY Departure Date* MM slash DD slash YYYY Hotel CategoryStandardSuperiorLuxuryNumber of Adults12345678 or moreNumber of Children1234 or moreChildren's AgeTransportation PreferencesRent a carShuttleDirect TransferPrivate TransportationI don't need transportationMedical/area required Dentistry Cosmetic Surgery Eye surgery Recovery retreat Spiritual growth and emotional healing Other (be specific)Complementary services requirement. Mark the required activities Physician/specialist appointment set up Exams/laboratory appointment set up Hospital/surgery room arrangements Traductor services Accompaniment over the surgery/procedure Nurse accompaniment over the visit All above services Are you intereset on complementary tours/activities? Yes No Please check the activities of your interest Beaches Volcanoes Rainforests National Parks Waterfalls Hot Springs Wildlife Nature Watching Sport Fishing Zipline River Float Horseback Riding Surfing Diving/Snorkeling Kayaking White Water Rafting Hiking Cultural and Shopping Coffe/Cocoa tours Nightlife Fine Dining Bird watching Yoga Coments and Special RequirementsPlease note that submission of this form does not constitute a confirmed booking. One of our agents will contact you at the contact number you provided and confirmation will proceed from there. We look forward to helping you and your friends/family have a safe and adventurous Costa Rica vacation! Δ
