Costa Rica

HighRoller Adventures Reservation Request
Call Terry Jertberg at (352)215 2925
or call (877) 205- 1764 Monday-Friday 9:00-6:00 CST to leave a message

Name:
Email Address:
Phone#:
Alt Phone#
Fax#:
Departure City:
Location of Interest:	Select Playa Nicuesa/Costa Rica Puerto Jimenez/Costa Rica Corcovado National Park/Costa Rica Crocodile Bay/Costa Rica Silver King Lodge/Costa Rica Sunset Beach Lodge/Australia Anglers Inn/Mexico Amazon Nemo, Brazil River Plate Outfitters, Brazil Explorer & Cutter, Brazil
Arrival Date:	Month January February March April May June July August September October November December Year 2006 2007 2008 2009 2010
Nights/Days:	Select 5 Nights/6 Days 6 Nights/7 Days 7 Nights/8 Days 8 Nights/8 Days
# of Adults:		# of Children:
Total# in Group:
Additional Info:
What other activities are you interested in? note: some activities may not be available at all locations
	Rainforest Trek	Mountain Biking
	Waterfall Rappelling	Gold Panning
	Bird Watching	Botanical Gardens
	Beach Exploration	Surfing
	SPA Services	Kayaking
	Snorkeling
How did you find out about HighRoller Adventures?		Select Internet Print Advertisment TV Advertisment Word of Mouth Outdoor or Boat Show Other
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