Checkout Survey

* Primary Guest Contact Information

First Name

Last Name

Address

City/Town

State

ZIP

Email Address

Phone Number

* Emergency Contact

First Name

Last Name

Phone Number

* Additional Participant Names

Guest 2

Guest 3

Guest 4

Guest 5

Guest 6

Guest 7

Guest 8

Guest 9

Guest 10

* Age

Primary Contact

Guest 2

Guest 3

Guest 4

Guest 5

Guest 6

Guest 7

Guest 8

Guest 9

Guest 10

* Mobility Level - Primary Contact

Choose One
---Great ShapeGood ShapeLimited

* Mobility Level - Guest 2

Choose One
---Great ShapeGood ShapeLimited

* Mobility Level - Guest 3

Choose One
---Great ShapeGood ShapeLimited

* Mobility Level - Guest 4

Choose One
---Great ShapeGood ShapeLimited

* Mobility Level - Guest 5

Choose One
---Great ShapeGood ShapeLimited

* Mobility Level - Guest 6

Choose One
---Great ShapeGood ShapeLimited

* Mobility Level - Guest 7

Choose One
---Great ShapeGood ShapeLimited

* Mobility Level - Guest 8

Choose One
---Great ShapeGood ShapeLimited

* Mobility Level - Guest 9

Choose One
---Great ShapeGood ShapeLimited

* Mobility Level - Guest 10

Choose One
---Great ShapeGood ShapeLimited

Allergies and/or Dietary Concerns

Primary Contact

Guest 2

Guest 3

Guest 4

Guest 5

Guest 6

Guest 7

Guest 8

Guest 9

Guest 10

Health concerns we should know about

Primary Contact

Guest 2

Guest 3

Guest 4

Guest 5

Guest 6

Guest 7

Guest 8

Guest 9

Guest 10

What type of lunch do you prefer?

Picnic/on the goSit down/restaurant-styleCombination of both depending on the touring schedule

What type of dinner do you prefer?

Local favorites (3 star)Fine dining (5 star)Combination of both depending on the touring schedule

Would you like us to make reservations on your behalf?

YesNo

What are your favorite road trip type snacks?

In addition to water, what other drinks would you like in the cooler?

Coke Products (please specify in box below)JuiceGatoradeCoconut WaterOther (please specify)

Special request of items for tour guide to bring

Step stool (for entering SUV)Hiking polesCamera tripodOther (please specify)

Are you celebrating any special occasions of which we should be aware?

NoYes (please specify)

Do you have any special interests you would like your guide to focus on?

GeologyHuman HistoryPhotographyDinosaursNight SkiesAdrenaline Activities

How did you hear about Utah Luxury Tours?

Web SearchTravel AgentReferral from a FriendOnline AdSocial MediaReturning CustomerOther (please specify)

Please fill out the following information for guests participating in additional excursions such as hot air balloon, rafting, horseback riding, or scenic air tours.

* Shoe Size (US)

Primary Contact

Guest 2

Guest 3

Guest 4

Guest 5

Guest 6

Guest 7

Guest 8

Guest 9

Guest 10

* Weight (lbs)

Primary Contact

Guest 2

Guest 3

Guest 4

Guest 5

Guest 6

Guest 7

Guest 8

Guest 9

Guest 10

* Height in feet and inches (Please include both (′) for foot and (″) for inch) Example - 5'8"

Primary Contact

Guest 2

Guest 3

Guest 4

Guest 5

Guest 6

Guest 7

Guest 8

Guest 9

Guest 10