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Project Himalaya Contract and Booking Form

I wish to book a place on (trip name):

Your full name:

Your email address /addresses:

Your current age:

Your home address:

Nationality:

Next of kin details:
Name and relationship
Phone and email

Are you vegetarian?
Any other special requirements?

We STRONGLY advise the over 50's to consult your doctor, have a thorough check up, cardiac stress test, and discuss trekking.

Do you have pre-existing medical conditions we should be aware of:

Have you ever suffered High Altitude Cerebral Odema
or High Altitude Pulmonary Odema before:

Do you suffer migraines or severe headaches or random blackouts:

I have travel insurance or am about to arrange some

I have read this Contract:

I have read and signed the Waiver, Release and Indemnification:

I have read payment methods and the relevant itinerary and information sheets.

I have or will send my flight details:

I have or will send a copy of my passport details page:

What name do you prefer to be called?

(and wait a few seconds to see the success message...)

 

last updated 08 February 2016

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