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KL Trekking Trip Application 2010

Fill out and send us the following form below or print and send any other documents by fax to 56-2-2174684 Print the form in PDF, and fill out (make sure to include signature) Fax this form along with your deposit to KL Adventure.

Fields mark as * are REQUIRED

* I have read and I accept the:

1. Your desire program:*

Patagonia

Torres del Paine Classic W Trek
Torres del Paine Full Circuit
Torres del Paine & Fitz Roy

Code	From	To	Status	Price	Promo
KLT001-01	Saturday, November 27, 2010	Friday, December 03, 2010	available	2,800	2,300
KLT001-02	Saturday, December 11, 2010	Saturday, December 18, 2010	available	2,800	2,300
KLT001-03	Saturday, January 08, 2011	Friday, January 14, 2011	available	2,800	2,300
KLT001-04	Friday, January 22, 2010	Friday, January 28, 2011	available	2,800	2,300
KLT001-05	Saturday, February 05, 2011	Friday, February 11, 2011	available	2,800	2,300
Universal Currency Converter

Code	From	To	Status	Price	Promo
KLT002-01	Saturday, November 20, 2010	Monday, November 29, 2010	available	3,500	3,000
KLT002-02	Saturday, December 04, 2010	Monday, December 13, 2010	available	3,500	3,000
KLT002-03	Saturday, January 08, 2011	Monday, January 17, 2011	available	3,500	3,000
KLT002-04	Saturday, February 05, 2011	Monday, February 14, 2011	available	3,500	3,000
Universal Currency Converter

Code	From	To	Status	Price	Promo
KLT003-01	Saturday, November 20, 2010	Sunday, December 05, 2010	available	4,500	4,200
KLT003-02	Saturday, December 04, 2010	Sunday, December 19, 2010	available	4,500	4,200
KLT003-03	Saturday, January 08, 2011	Sunday, January 23, 2011	available	4,500	4,200
KLT003-04	Saturday, February 05, 2011	Sunday, February 20, 2011	available	4,500	4,200
Universal Currency Converter

Atacama

Select a date

Easter Island

Select a date

Aconcagua South Face

Select a date

Other:

Product

US $

Tents: North Face - Mountain Hardware Marmot

150

Internal frame Backpack (50 liters)

100

Sleeping bag -11 degrees C with silk liner

100

Gaiters

Crampons compatible with your boots

Harness

Trekking adjustable ski poles

Ski Goggles

Duffel bags (120+ liters)

Universal Currency Converter

Other not listed:

6. How did you learn about KL Adventure?*
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KL Adventure SA

Ski Tours, Heliski, Expeditions & Treks in the Andes.
Aconcagua - Atacama Desert - Torres del Paine - Ojos del Salado - Mt. Vinson Antarctica & Bolivia mountains.

Head Office: Augusto Mira Fernandez 14248, Las Condes, Santiago, Chile
Phones: (56-2) 217 9101 & 955 12 54
Mobile: (56-9) 9 018 22 55 - Fax: (56-2) 217 46 84

(1) 307 200 49 25 Jackson Wyoming, USA	(44) 20 813 329 25 London United Kingdom	(61) 2 800 376 80 Sidney Australia	(55) 11 302 007 15 Sao Paulo Brasil	(56) 2 570 88 51 Santiago Chile
Call Us Locally from 09:00 to 17:00 Hrs (Chile time)
Current Chile Time:

All Photos taken by Joaquin Oyarzún, except indicated as * -

- Site Map - Web Site designed & developed by Graphictronics

2. Client Information
Name:	*
Address:	*
City:	*
State:	*
ZIP / Postal Code:
Country:	*
Other Country:
Home Phone:	*
Work Phone:	*
Mobile Phone:	*
Email:	*
Occupation:	*
Passport Nr:	*
Issue date:	*
Expire date:	*
Nationality:	*
Age:	*
Date of Birth :	* (Month, DD, YYYY)
Height:	*
Weight:	*
Shoe Size:	*
Blood group / Rhesus factor:	*
3. Contact in case of emergency
Name:	*
Phone Home:	*
Phone Mobile:	*
Relation:	*
Email:	*
Address:	*
City:	*
State:	*
Zip Code:
Country:	*
4. Medical Information
Known allergies or incapability’s:	Yes No *
Previous important medical problems & history:	Yes No *
Emergency medicine for known problems:	Yes No *
Any disability or problem KL needs to know :	Yes No *
4. Trekking
Please specified clearly : year, trekking routes, maximum trekking hours achieved, company & guide with whom you have done it	*
Skills & Interests
5. Special requirements
Diet Special Requirement:	Yes No *
Single Room Hotel Reservation Note: Single supplement concern ONLY hotel booking and NOT the single tent use during the trekking programs. Please contact us in case you desire a single tent supplement all time.
Trekking Equipment:	Yes No*