EmailMe Form - Trekking in the Himalayas ~ Bhrigu Lake

Name *

First Last

Age *

Sex *

Male

Female

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone (Residence) *

Phone (Mobile) *

Emergency Contact Number *

Blood Group *

Email *

Profession *

Nationality *

Prior Trekking Experience (if any)

Are you suffering from any medical condition, illness or injury? *

Yes

No

If yes, please specify

I accept full responsibility and consider myself physically, mentally and medically fit to be a part of this trek? *

Yes

You would be required to sign a waiver form at the start of the trek. *

I agree

How did you come to know of this trek? *

Bhrigu Lake

Mode of Payment (select any one): *

Cheque: In favour of "Alpine Wanderers Pvt. Ltd."

Bank Tansfer/Cash Deposit: HDFC Bank; Branch: Anand Niketan, New Delhi; Name: Alpine Wanderers Pvt. Ltd., Account No.: 03362000004314; Account Type: Current; NEFT/IFSC Code: HDFC0000336

Already Paid For

Cancellation Policy:
Prior to 30 days from the start of the trip: Full refund
Between 30 & 15 days to the start of the trip: 50% refund
Less than 15 days to the start of the trip: No refund *

I agree