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Sample form

Nepal Mountain Trekking - Trip application form

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Please complete, sign and fax at: + 977 1 4700898 with an advance of non-refundable bank deposit of US$ 200.00/- per person for the selected trip in the following bank detail:

Beneficiary: Nepal Mountain Trekking (P) Ltd. - Thamel - Kathmandu
A/C No: 010100061134
Bankers: Bank of Kathmandu Ltd. Kathmandu - Nepal
Telex No: 2820 BOK NP
Swift code: BOKLNPKA

I have applied to participate in (check trips applied for & single supplement option if desired) ......................................................... ............................................................................................ with my personal information as follows:

Name (as in Passport)......................................................................................................................................

Street address.................................................................................................................................................

City, State, Zip................................................................................................................................................

Home phone................................................. E-mail.........................................................................................

Birth date (D/M/Y)...........................................................................................................................................

Birth Place......................................................................................................................................................

Nationality (your passport issued country).........................................................................................................

Passport number.............................................................................................................................................

Profession .................................................Are you vegetarian / non-vegetarian? .............................................

Trekking experience........................................................................................................................................

Please specify if you have any comments..........................................................................................................

.....................................................................................................................................................................

.....................................................................................................................................................................

SIGNATURE....................................................................... DATE....................................................................

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