TREK RESERVATION FORM

Print this page, fill it out and fax or mail it to:

2001 NFB Everest Expedition
c/o PV Scaturro
1680 Hoyt Street
Lakewood, CO 80215
Phone: 303-238-9330
Fax: 303-239-6065
Email:

Trek Reservation Form and Personal Information Sheet (to reserve a space on this trek, please return this form and a $350 deposit per person -- checks should be payble to the 2001 NFB Everest Expedition)

Full Name: __________________________________________________________________________

Address: ____________________________________________________________________________

Home Phone: _______________________________ Work Phone:______________________________

Fax: ______________________________________ E-mail:___________________________________

Date of Birth: ___________________________ Place: _______________________________________

Passport Number: ______________________________ Country issued: ________________________

Passport Date of Issue: __________________________ Expiration Date: _______________________

Emergency Contact Information: ________________________________________________________

____________________________________________________________________________________

Statement of Risks, Assumption of Risks, and Release Form

I am aware that during the mountain trek that I am participating in under the arrangements of Wilderness Experience Pvt. Ltd. and its agents or associates, certain risks and dangers exist, including but not limited to the hazards of traveling in mountainous terrain, accident or illness in remote places without medical facilities, the forces of nature, travel by air, train, automobile, or other conveyance. The weather in the mountain is unpredictable and can change rapidly. Slips, falls, rockfall, avalanches, floods, lighting strikes, and other traumatic events are possible as are serious medical conditions such as hypothermia, any of which could lead to permanent injury or death. I understand that the leaders of the trek are well-trained but may make mistakes and/or may be unable to solve problems or prevent accidents. Therefore, I understand that my personal safety depends largely upon my alertness, upon my care and attention to the environment and to my physical and emotional state, and upon my use of good judgement. I further understand that it is my responsibility to understand, to assess and to accept or reject any and all plans set forth by trek leaders.

In consideration of, and as part payment for, the right to participate in this trip or other activities and the services and goods arranged for me by Wilderness Experience Pvt. Ltd. and its agents or associates, I have and do hereby assume all of the above risks and will hold the above mentioned company, owners, agents and associates harmless from any actions, causes of actions, suits, debts, demands, and claims of any kind which I now have or which may arise in connection with this trip.

By signing below, I acknowledge that I have read, understand and do agree to the terms and conditions set forth in the above statement.

Signed: ________________________________________________ Date: _______________________