Wilderness Adventure Reservation Form

 

  2. First Name:
  4. Last Name:
  1. Your email address:
  3. Home Phone:
  5. Work Phone:
  7. Fax:
  1. Mailing Address:

  3. City:
    State/Province:
  5. Country:
    Zip/Postal Code:
  7. I wish to participate in the following Trip:
  9. Departure Date:
  11. The number of persons travelling in my group:
  14. I have the following handicaps or physical conditions that require special attention:
  16. I have the following special diet requirements:
  18. Please provide a name, address, phone, and your relationship to a person we can
    contact in case of an emergency:

  21. I prefer smoking: non-smoking
  23. Birthdate:
  25. Additional comments or questions for "Tundra Tom"

 

  2. Note: Each indiviudal will be required to read and sign a trip registration form
    & a Mandatory Release and Assumption of Risk     agreement prior to joining any
    of our trips & expeditions    .

  3. Please click here to download and print the trip registration form in PDF.

 

 

| Main | Please send more Information | Email Us|