Trek or Expedition Booked :-

 

Name (exactly as on passport)

 

Emergency Contact

 

Address                                                   

 

 

 

Address

 

 

Telephone
Home/Mobile Phone                    

Work Phone (if OK to use)

Do you have any medical condition we should know about such as diabetes, asthma or an old injury?

 

 

 

Email address
Date of Birth                 
Occupation
Nationality                               Passport no.                                   Expiry date
Give a brief outline of your relevant walking, climbing or skiing experience

 

 

How high have you been before?
Are you vegetarian or vegan?

Is there any food you particularly dislike?

And any you particularly like?

Are you interested in a social day or winter skills weekend for your trip?
Do you want information about insurance?
Where did you first hear about us?

 

Do you want us to book flights for you?
Please indicate any preferred departure airports

Declaration

I have read and understood the booking conditions and agree to abide by them. I have read and accepted the risk assessment for this adventure holiday as detailed in the dossier. I enclose a non-refundable deposit of £500/US$800/Euro700 (or equivalent in other currency) per person booked. Please make cheques payable to Andes Trust Account

Signature..............................................................Date......................................................