Application and Reservation Form for Kohinoor Adventure (P) Ltd. Kathmandu, Nepal

KOHINOOR ADVENTURE
APPLICATION AND RESERVATION FORM

Submission of this form is necessary for sightseeing, trekking and mountaineering journeys with Kohinoor Adventure (P) Ltd. Please read this form carefully, fill it in, check the Accept box, and select the submit button:
(This form can also be used if you need more information)
If you are interested in climbing an Expedition Peak, there is an official government form that you need to submit also

Name of Trip:
Date of Departure from USA:
Date of Arrival in Kathmandu:
Email address:
Applicant Name:
(Each person needs one form)
Mailing Address: Street:
City:
State: Zip Code:
Home Phone: Business Phone:
Fax Number:
Age: Male: Female:
Occupation:
Passport No.:
Date Issued: Place Issued:
Expiration Date:

Birth Date: Place of Birth:
Citizenship:
Photocopy of Passport needs to be sent.

I want to share my double room with
I prefer a single room and I'm willing to pay the extra single supplement
(At hotels only - Not available at certain lodges.)

IN CASE OF EMERGENCY PLEASE NOTIFY:
Address:
Home Phone: Business Phone:
Fax No. Relationship:

RELEASE OF LIABILITY AND ASSUMPTION OF ALL RISKS: I acknowledge that I am voluntarily participating on this adventure travel trip where medical attention and evacuation may not be adequate or available, and I acknowledge the risk and hazards of travel to a remote area where injury, illness and even death may occur, I hereby accept responsibility for my own welfare, I accept any and all risks that may arise in connection with this trip. I hereby release, discharge, and hold harmless Kohinoor Adventure (P) Ltd., its' owner, agents, employees, associates, suppliers, and affiliated companies from any and all liability arising from my participation on this trip. The terms hereof shall serve as release assumption of risk for myself, my heirs, administrators, and executors and for all members of my family.

Name:
Date:
I accept the release of liability:

Here is a space for you to write other questions or comments or if you need more information:

Terms and Conditions - BioData Form
Mountaineering Expedition Application

Home Page - Trekking Peaks - Sample Treks
What It's Like - Trekking Connections - Equipment List
Photo Galleries - Links

All photos, images and text are copyright © 2000-2005 by
Kohinoor Adventure (P) Ltd.
All rights reserved.