Costa Rica LIU Registration

First Name as it appears on passport (required)

Middle Name as it appears on passport (if applicable)

Last Name as it appears on passport (required)

Passport Number

Country of Issue (required)

Passport Issue date

Passport Expiry date

Date of Birth (required)

Country of Birth (required)

Mailing Address (required)

City (required)

State/Province (required)

ZIP/Postal Code (required)

Telephone (required)

Your Email (required)

I am: FemaleMale

I want a (required): Single RoomDouble RoomTriple Room

(Optional) My roommate(s) will be:

If you have any special requests, such as a special diet or physical limitations, please describe them below...

Optional Message

I understand that RMC highly recommends the purchase of Trip Cancellation Insurance, and our preferred Insurance provider is Allianz.

(required) I understand and accept the Terms and Conditions for this program.
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