Trek or Expedition Booked :-
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Name (exactly as on passport)
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Emergency Contact
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| Address
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Address
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| Telephone | |
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Telephone Home
Work |
Do you have any medical condition we should know about such as diabetes, asthma or an old injury?
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| Email address
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| Date of Birth | |
| Occupation | |
| Nationality Passport no. Expiry date | |
| Give a brief outline of your relevant walking, climbing or skiing experience
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| How high have you been before? | |
| Are you vegetarian or vegan?
Is there any food you particularly dislike?
And any you particularly like?
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Will you be interested in a social day or winter skills weekend for your trek or expedition?
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| Do you want information about insurance?
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| Where did you first hear about us?
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| Do you want us to book flights for you? | |
| Please indicate any preferred departure airports | |
DeclarationI 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 deposit of £300/US$500/Euro500 (or equivalent in other currency) per person booked. Please make cheques payable to Andes Trust AccountSignature..............................................................Date........................................................ |
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