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 | |
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 non-refundable deposit of £500/US$800/Euro700 (or equivalent in other currency) per person booked. Please make cheques payable to Andes Trust AccountSignature..............................................................Date...................................................... |
|