Trip Reservation | Rolwaling Excursion

Trip Booking Form

Trip Information

Trip Name*

Trip Code*

No. of Traveller*

Trip Duration*

Arrival

Departure

Personal Detail (Lead Traveller)

Title*

First Name* As in passport

Middle Name(s)

Surname*

Date of Birth*

Gender*

Nationality*

Occupation

Passport Details

Passport No.

Passport Issue Date

Passport Exp. Date

Contact Details

Contact Number*

Email*

Mailing Address

Medical Details

Height (cm).

Weight (kg)

Blood Group

Medical Conditions and/or Problems? Please use this space to tell us of any medical problems that you may have now or had in the past. Please list any medical conditions, no matter how insignificant it may seem to you. This is important for your safety. Please do not leave this blank - put none if not applicable.

Medications? Please list the exact name of any medication that you take, including the appropriate dosage. Please do not leave this blank - put none if not applicable.

Allergies and/or dietary requirements? Please inform us of any special dietary requirements that you have. This should include any allergies and religious based eating requirements. Please do not include general likes and dislikes. Please do not leave this blank - put none if not applicable.

Emergancy Contact

Name

Contact Relationship

Contact Phone Number

Contact Address

Traveller Insurance Details

Name of Insurer

Your Policy Number

Insurance Contact Number

Additional Info...

Additional Notes Please use this area to give us any additional notes such as if you are travelling with a friend or if you wish to talk over flight options.

Where did you hear about Rolwaling Excursion*

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