Activity Registration Step 1 of 4 25% Enjoy 15% discount for travel gears at X-Boundaries when you join an adventure with us! * denotes compulsory entryDestination*Start Date* End Date* Participant’s ParticularsName (as in passport)*Passport (PP)*PP Expiry Date* Birth Date* Nationality*Gender*FemaleMaleAge*Occupation*Marital Status*Contact Number*Email Address* Home Address* Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Meal Preference/ Allergy Person To Notify In Case Of EmergencyEmergency Contact Name*Relation*Emergency Number* Please Describe Your Health And Outdoor BackgroundTrek ExperiencePlease describe your trek experience in shortDrug Allergy*I do not ever have or am still having any of the following:*AgreeDisagreeEpilepsy, fainting attacks, migraine, severe head injury, Previous fractures, tendon/ligament damage, Previous operations, Suffering from or carrier of any infectious disease (e.g. hepatitis B), Physical disabilities, On medications now, Other past illnessesIf disagree, please give detailsRemarks ASSUMPTION OF ALL RISKS AND RELEASE OF LIABILITY* Agree I am aware that my/my child's/my ward's attendance in the expedition under the arrangements of X-Trekkers Adventure and its agents or associates, involves a certain amount of risk. It is also intended only for those without significant medical problems (including recent infections or injuries). I shall not hold the X-Trekkers' staff, agent or contractor responsible for any damage to or loss of property or any injury or loss of life which may be sustained by me/my child/my ward during the expedition or arising from any cause in connection with the trip. I have also carefully read and do agree to all the conditions as stated under the heading “Terms and Conditions”, especially noting the policy on cancellations and refunds. I have also carefully read the above paragraphs, Assumption of All Risks and Release of Liability.Travel Insurance* Agree I acknowledge to have being advised by X-Trekkers of purchasing a comprehensive “travel insurance policy” to protect myself/ourselves against unforeseen circumstances such as baggage loss, flight delays, travel agent solvency and medical emergencies.CAPTCHA This iframe contains the logic required to handle AJAX powered Gravity Forms.