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CBF PTP Application Form

OFAC People-to-People Travel Program to Cuba - Application Form

* Indicates required question

What is today's date? *

YYYY

First Name *

Your answer

Last Name *

Your answer

Mother's Maiden Name *

Your answer

E-mail Address *

Your answer

Home Address *

Your answer

Apartment / Suite #

Your answer

City *

Your answer

State

Your answer

Zip Code

Your answer

Country *

Your answer

Date of Birth *

YYYY

Occupation

Your answer

Marital Status *

Choose

Single

Married

Separated

Divorced

Civil Union

Passport Number *

Your answer

Passport Expiration Date *

YYYY

Are you traveling with a Group / Organization? If so, what is the name?

Your answer

What region are you visiting? *

Choose

Cuba

Brazil

Argentina

Puerto Rico

If born in Cuba, when did you leave?

If born in Cuba, you will need to fill out additional paperwork and obtain another visa. Please contact us immediately so that we can guide you through this process.

Before 1970 with Cuban Passport

Before 1970 without Cuban Passport

After 1970 with Cuban Passport

After 1970 without Cuban Passport

Clear selection

What date does your travel program begin? *

Enter the date you arrive in the desired region, not the date you leave your hometown.

YYYY

What date does your travel program end? *

Enter the date you leave the region, not the date you arrive back at home.

YYYY

How many times have you traveled to the designated region? *

Your answer

If Cuba, which license did you use?

Your answer

Emergency Contact - Name *

Your answer

Emergency Contact - Relationship

Your answer

Emergency Contact - Phone Number *

Your answer

Emergency Contact - Address

Your answer

Which Hotel are you staying in?

Hotel Nacional

Hotel Saratoga

B&B / Casa Paricular

Other

I don't know

Clear selection

What Type of Room would you like?

Standard Single

Standard Double (1 large bed)

Standard Double (2 beds)

Executive Floor in Hotel Nacional

Junior Suite

Highest Upgrade / Best Room Available

Other

Clear selection

If sharing a room, who is your roommate?

Your answer

Please write your full name to confirm that you are a licensed traveler to Cuba and authorize Gypsy Travel Service to assist on your behalf with the application to obtain and receive an entry permit to Cuba.

Your answer

Please write your full name to sign the following: This agreement sets forth the terms and conditions under which we, Gypsy Travel Service, in return for payment of the amount indicated as the determined total program price. We, as the principal, are responsible to you for arranging the travel program, provided, however, that in the absence of negligence on our part, we are not responsible for personal injury or property damage caused by the air carrier or other suppliers

Your answer

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