Registration Form

Personal Details


Title *
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Ful Name *
Address *
State *
Mobile Phone *
Home Phone *
Email *
Occupation *
Date of Birth *

Passport Details


Nationality *
Passport Number *
Place of Issue *
Date of Issue *
Expiry Date *

Frequent Flyer Program


Departure Port *
Departure Date *
Arrival Port *
Arrival Date *

Emergency Contact


Contact Name *
Relationship *
Address *
Contact Phone *

Travel Insurance


Travel Insurance Company *
Policy No *
Helicopter Evacuation Cover *
Coverage Dates from *
Expiry Date *

Pre-Existing Medical Conditions


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Terms & Conditions


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Buddha Marg, Golfutar
Email: info@himalayanhikers.com

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