Electronic Booking Form

These Trips have limited space - they can close to new bookings at any time so Guarantee your place by booking on line with this form. Your place will be reserved for 10 days pending receipt of your payment and signature.

After you have requested entry online, print and mail this form with full trip payment to: Booking Agent

Begin Form

E-Mail Address:

Mr. Ms. Mrs.
First Name

Last Name

Address:

City
State
Postal Code

Country:

Phone Home:

Phone Work:

Fax:

Sex Male Female

Occupation:

Marital Status:

Emergency contact:

Select Trip
Stage Race .......(8 day trip),
Everest Challenge Marathon ....... (4 day trip),
Mt Everest Bike Rally .........(8 day trip)

I am a: Runner Walker Cyclist

T-Shirt Size: Medium Large X-Large

Smoker Yes No

Room share preference:

Passport details:

Exact name as it appears:

Number
Date Issued:

Where Issued:

Date Expires:
Date of Birth:
Age:

Place of Birth:

Citizen of:

I have read the Booking Conditions and they form part of this contract. I accept the terms and conditions as stated in this contract. Please use a separate Booking Form for each person booking a trip. Space is limited. All entrants mail the completed Booking Form and full payment. Foreign entrants can wire funds or use a bank check payable to Booking Agent.. A complete Pre-departure Package will be mailed when your booking is confirmed.

Signature:_________________________________________________
(please sign printed form before mailing)

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