Click on your browser File option and select Print to print this form. Please complete using block letters, sign and
fax at: + 977 1 4700769 with a non-refundable bank deposit of US$ 200 each for the selected trip in the
following bank detail:
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Beneficiary: High Mountain Wave Trekking (P) Ltd. - Thamel - Kathmandu
A/C No: 00 106250019
Bankers: HIMALAYAN BANK Ltd - Tridevimarg - Kathmandu - Nepal
Telex No: 2789 HIBA NP; Swift code: HIMANPKA; Click here to pay by Credit Card
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I have applied to participate in (check trips applied for & single supplement option if desired)................................ |
| ...........................................................................................................................with my personal information as follows: |
| Name (as in passport) .............................................................................................Sex (M/F)............ |
| Street address ................................................................................................................................ |
| City, State, Zip ............................................................................................................................... |
| Home phone................................................ E-mail ......................................................................... |
| Date of birth (D/M/Y) ................................................... Birthplace ...................................................... |
| Nationality (your passport issued country) ........................ Passport number.......................................... |
| Date of issue (D/M/Y) ............................................date of expiration (D/M/Y) ....................................... |
China Visa Info:
visas number.................................................... Type of visas.................................... Visa validity........................... |
| Occupation ....................................................Are you vegetarian/ non-vegetarian? ............................ |
| Hiking experience/ How high have you been before?............................................................................ |
| Please specify if you have any comments.......................................................................................... |
| ...................................................................................................................................................... |
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TERMS AND CONDITIONS AND RELEASE OF LIABILITY
I understand that risks, both foreseeable and unforeseeable, are inherent to undertaking the trip listed above. I also understand that I am solely responsible for all of my personal possessions and in the matter of part payment for, the right to participate in this kind of trip and the services and food arranged by High Mountain Wave Trekking (P) Ltd. and its agents or associates will not be liable for any actions, causes of actions, debts, claims of demand of every kind and nature whatsoever which I now have or which may of in connection with my participation in this trip. I certify that I am in a good physical condition and have no disabilities, which might impair my ability to complete the trip in a safe manner. The terms hereof shall serve as a release and assumption of risk for my heirs, executors, and administrators and for all members of my family including any minors accompanying me.
I have read and agree to the conditions stated herein. |
