libby peter

Name *

Address *

Contact phone number *

Email Address *

Emergency contact name *

Emergency contact telephone number *

Description of booking/activity *

Other members of group

Total Fee *

Date/s of booking *

* Are you undergoing, or have you recently received, medical treatment, or do you have any illness or disability that may affect you during your stay * Are you undergoing, or have you recently received, medical treatment, or do you have any illness or disability that may affect you during your stay YesNo

If YES, please supply details. It is essential that we know of any medication that you are taking (or have been taking) or medical condition that you have which may be affected by mountain activities, physical exercise or high altitude.

I recognise that all mountain activities are dangerous and can cause serious injury or death. * I recognise that all mountain activities are dangerous and can cause serious injury or death. * Yes I recognise that all mountain activities are dangerous and can cause serious injury or death

Overseas only - I have arranged cancellation, medical, repatriation and rescue insurance for unrestricted Alpine mountain activities as appropriate in Europe. Overseas only - I have arranged cancellation, medical, repatriation and rescue insurance for unrestricted Alpine mountain activities as appropriate in Europe. Yes I have arranged cancellation, medical, repatriation and rescue insurance for unrestricted Alpine mountain activities as appropriate in Europe.