Trip Application

Please fill up the form given bellow as complete as possible.

GENERAL INFORMATION

Last Name:
First Name:
M.I.
Occupation
E-mail address:
Address:
Country:
City:
State:
ZIP
Home Phone: (with area code)
Work Phone: (with area code)
Are you taking any medication? Yes No
If yes, please explain
   
Please explain your hiking, camping and climbing experience:
   
Have you travelled out side of United States? Yes No
If yes, please list the countries:

EMERGENCY CONTACTS (please provide two)

Name:
Relationship:
Address:
Telephone:
E-mail address:
   
Name:
Relationship:
Address:
Telephone:
E-mail address:

Personal Information

Date of Birth:
Sex: Male Female
Marital Status:
Relationship:
Do you have a valid passport? Yes No
Passport #:
Country of Issue:
Expiration Date:


Initial Below

I understand that as a participant in Hike For Help Nepal, I will function as a full volunteer, paying my own travel, maintenance and other incidental expenses.
I understand that travel and living conditions are difficult and different from my conditions in Nepal, and I posses the necessary skills and capability to camp outdoors for an extended period of time.

I understand that I will be working in a cross cultural setting with a group of individuals from varied backgrounds and sometimes very different value systems.

I understand that overseas travel and work requires reasonably good physical conditioning and it is my responsibility to inform HIKE FOR HELP NEPAL of any health problems or concerns I may have.
I understand that the availability of sophisticated medical care is limited, especially in rural and backcountry regions.

 

  Please download this file and print it, then fill up the form completely, and then scan it and attach below to complete your trip application.
Attach Scan page 1
Attach Scan page 2
Attach Scan page 3
Attach your passport size photo
Access Code verification code
(Put above code here)
 
Trip Application

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