Your Information:
Cuba Program Name (scroll down) (*)
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First Name (as it appears on your passport) (*)
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Last Name (as it appears on your passport) (*)
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Street Address
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City
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State
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Zip
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Primary Phone (*)
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Email Address (*)
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Passport Information:
I am a citizen of (*)
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Passport Number (*)
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Expiration Date (*)
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Date of Birth (*)
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Gender (*)
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Person to contact in case of emergency
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Emergency Phone Number
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Rate your Spanish language ability
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Accommodations:
Sharing a room or single occupancy?
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I wish to share a room with
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List any special dietary needs, medical conditions, or disabilities that may affect your participation in this program
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Did you read Proximity Cuba´s TERMS AND CONDITIONS? (*)
You must check the TERMS and CONDITIONS
- OFAC Travel Affidavit
In order to travel legally to Cuba, program participants must qualify for one of the two licenses authorized by the U.S. Department of the Treasury Office of Foreign Assets Control (OFAC). Participants for this trip will be traveling under the General License, called the "people-to-people" educational travel.
a) General licenses: OFAC has authorized people to travel to Cuba under one of twelve “general license” categories. Individuals who meet the requirements of one of the twelve general license categories do not need to apply to OFAC. If this is your case, you must provide a signed travel affidavit to us that we have to keep for five years as required by OFAC. Download ProximityCuba Travel Affidavit
b) Specific licenses are issued only in certain cases to the traveler directly by OFAC. ProximityCuba participants must provide the specific license number along with a copy.
Send to ProximityCuba the filled out and signed Travel Affidavit. Please make sure you select the Category of the OFAC General License that applies for your program
This file is required
Please upload your Travel Affidavit filled (PDF format, max 5 MB).
- Passport copy
Copy of your U.S. passport valid at least 4 months beyond the date of the trip’s return. (use the field Copy of your Passport main page -where your photo and main information is- of the form below).
* If you are a citizen of another country, you must have a valid passport of that country along with U.S. residency permit or visa with multiple entry permitted, also valid at least 4 months beyond the date of the trip’s return.
* If Cuban born, you must hold either a valid and stamped Cuban passport or if you left Cuba prior to January 1, 1971, a U.S. passport and a PE-11 entry permit.
Please take a photo of the main page of your passport and attach it, we strongly recommend to print it and bring to Cuba with other documents.
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Passport valid at least 4 months beyond the date of the trip’s return. (Max 5 MB)
- RESPECT Travel Affidavit
ProximityCuba is a member of RESPECT (Responsible and Ethical Cuba Travel), an U.S. professional association uniting nonprofit entities, travel agents, tour operators and other travel service providers dedicated to practicing and promoting ethical and socially responsible travel to Cuba.
We request our participants to sign the RESPECT Travel Affidavit. Download RESPECT Travel Affidavit
Send to ProximityCuba the filled out and signed RESPECT Travel Affidavit
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(Max 5 MB)
