Application Form

I have read and I accept the:

• Acknowledgment of and Assumption of Risks
• KL Adventure Policy

1.-Select your desire Program

Trekking

Expedition

Other:

Program Name:

Code:

Dates:

Full Name:

Address:

City:

State:

Zip Code:

Country:

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Other Country:

Phone:

Cell:

Fax:

E-mail:

Passport N°

Passport Issue Date

Passport Expire Date

Nacionality:

Occupation:

Date of Birth:

Place of Birth:

Gender:

Male Female

Height:

Weight:

Blood group / Rhesus factor:

Known allergies
or incapability’s:

Previous important medical problems and history:

Emergency medicine for known problems:

Name:

Address:

Phone:

Mobile Phone:

Fax:

E-mail:

Another E-mail (If have):

Please specified clearly year, mountain, route, altitude achieve, companies & guide who did you participate with:

Hotel Reservation

Single

Double Twin

Double King

Other specified :

Reference from other people

Advertisement (specified):

Internet

Press article (specified):

Other Specified:

Attached you will find the amount of:

Deposit Reservation US$

Total Balance US$

Form of Payment

Credit Card

Check to KL Adventure Ltd.

Wire transfer