Iceland Client info Form Names * Exactly as it appears on your passport First Name Last Name Middle Names River(s) and Lodge(s) * Please indicate where you are fishing in order Arrival Date * Please indicate date of arrival at the fishing lodge MM DD YYYY Arrival Flight or Hotel (for Transfer) * Departure Date Please indicate date of departure from the fishing lodge MM DD YYYY Departure Flight or Hotel (for Transfer) Transfers Required? * Please indicate if you require us to quote for transfer to and from the lodge Yes No Fishing With Add name if known Rooming With For rod sharing Your Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Telephone * Please include international code Email * Date of Birth * MM DD YYYY Nationality * Passport Number * Passport Expiry Date * MM DD YYYY Travel Insurance Provider Travel Insurance Policy Number Allergies, Illness & Medication * If none please write N/A so we know you have considered this question Emergency Contact Name Relationship Emergency Contact Number Any Special Requests Such as which guide you might prefer. We try our best to accommodate all requests where we can Thank you! Your details have been submitted and you will receive a notification via email. Please open this email to confirm you have received it.We will be in touch directly if we need any further information. We look forward to seeing you at the lodge.
