Application Form for trekking in Nepal, Tibet, India, Pakistan, Sikkim and Bhutan treks and tours with Peter Owens' Asian Treks

PETER OWENS' ASIAN TREKS 2007 — APPLICATION FORM

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I HAVE APPLIED TO PARTICIPATE IN (CHECK TRIPS APPLIED FOR & SINGLE SUPPLEMENT OPTION IF DESIRED):

TREK NAME __________________________________________________ LODGE/CAMPING

DATES: KTM ARRIVAL ____________________ KTM DEPARTURE ____________________

NAME (as in passport) ______________________________________________________________

STREET ADDRESS _________________________________________________________________

CITY, STATE, ZIP __________________________________________________________________

HOME PHONE _________________________ E-MAIL ____________________________________

BIRTH DATE _____________ AGE _______ BIRTHPLACE ________________________________

COUNTRY OF PASSPORT _____________________ PASSPORT # ___________________________

DATE OF ISSUE _______________________ DATE OF EXPIRATION ___________________________

PROFESSION ________________________________________ ARE YOU A VEGETARIAN? ________

BRIEFLY DESCRIBE YOUR HIKING EXPERIENCE MENTIONING HOW MANY MILES PER DAY AND ELEVATION GAIN PER DAY YOU ARE COMFORTABLE WITH. WHAT IS HIGHEST ALTITUDE YOU HAVE HIKED AT? HIGHEST SLEPT AT? IF YOU ARE JUST APPLYING FOR THE TIBET TRIP, GIVE DETAILS OF YOUR RECENT PREVIOUS FOREIGN TRAVEL EMPHASIZING ANY TRIPS TO UNDEVELOPED AREAS UNDER PRIMITIVE CONDITIONS.

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RELEASE AND ASSUMPTION OF RISK
I am aware that during the mountain trip I am participating in under the arrangements of Peter Owens' Asian Treks and Himalayan Treasures & Travel and its agents, certain risks and dangers may occur including but not limited to, the hazards of crossing mountainous terrain, accident or illness in remote places without medical facilities or means of rapid evacuation, the dangers of civil disturbance and war, the forces of nature and travel by air, automobile, bus, jeep and other conveyance. In consideration of, and as part payment for, the right to participate in such mountain trips and the services and food arranged for me by Peter Owens' Asian Treks and Himalayan Treasures & Travel and its agents or associates, I have and do hereby assume all of the above risks and will hold harmless from any and all liability actions, causes of actions, debts, claims of demand of every kind and nature whatsoever which I now have or which may arise of or in connection with my participation in this trip. The terms hereof shall serve as a release and assumption of risk for my heirs, executors, and administrators and for all members of my family including any minors accompanying me. I have read and agree to the conditions stated herein.

SIGNATURE __________________________________________ DATE ___________________

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