Full Name Gender Date of Birth (DD/MM/YYYY) Nationality Passport Number Date of Issue Expiry Date Place of Issue Contact Information Email Address Phone Number (with country code) Emergency Contact Name Emergency Contact Phone Number Relationship to Emergency Contact Travel Information Preferred Trek/Trip Name Preferred Trek/Trip Dates Are you traveling alone or with a group? AloneGroup If traveling with a group, how many people in your group? Do you need an airport pick-up service? YesNo Arrival Date and Flight Details Departure Date and Flight Details Health and Fitness Information Do you have any pre-existing medical conditions? YesNo If yes, please provide details: Do you have any allergies? YesNo If yes, please specify: Are you currently on any medication? YesNo If yes, please provide details: Have you participated in any trekking or adventure activities before? YesNo How would you rate your current fitness level? BeginnerIntermediateAdvanced Do you have any special dietary requirements? YesNo If yes, please specify: Emergency Medical Insurance Do you have travel/medical insurance? YesNo Insurance Provider Name Policy Number Emergency Contact for Insurance Phone Number for Insurance Contact Terms and Conditions I understand that a non-refundable booking fee of €150 is required to secure my place for the trek/trip. Agree I acknowledge that all money raised during the trek will go towards VIN’s community development projects. Agree I agree to pay the remaining trek fee during the induction process. Agree I understand that the trek may involve physical activities and take place in remote areas, and I assume all risks involved in the journey. Agree Signature Date (DD/MM/YYYY)
