I have applied to participate in *** Select your trip *** Trishuli River Rafting Kali Gandaki River Rafting Sun Koshi River Rafting Bhote Koshi River Rafting Marshyangdi River Rafting Seti River Rafting Karnali River Rafting Arun River Rafting Tamur River Rafting Other River Rafting with my personal information as follows:

Name (as in passport)
Sex (M/F)
Street address
City, State, Zip
Home phone
E-mail		*
Your insurance provider
Your insurance policy number
Emergency Contact Phone
Emergency Contact Name
Your relationship
Birth date (D/M/Y)
Birthplace
Nationality		(your passport issuing country)
Passport number
Date of issue (D/M/Y)
Date of expiration (D/M/Y)
Your Profession
Are you vegetarian / non-vegetarian?
Rafting experience
Please specify if you have any comments.
Access code

SIGNATURE (Type your Name)     DATE