| Please
complete,
sign and
fax at:
+ 977-1-4700769
with a non-refundable
bank deposit
of 30% of
the total
amount of
the selected
trip in
the following
bank information: |
| |
Beneficiary:
Mountain
River
Rafting
(P) Ltd.
- Thamel
- Kathmandu
Bankers:
HIMALAYAN
BANK Ltd
- Tridevimarg
- Kathmandu
- Nepal
Telex
No: 2789
HIBA NP
A/C No:
00058270018
|
| |
| I have
applied
to participate
in (check
trips applied
for &
single supplement
option if
desired)........... |
| .......................................................................................................................with
my personal
information
as follows:.................................................................................... |
| Name (as
in passport)
.................................................................................................. |
| Street
address
............................................................................................................. |
| City,
State, Zip
............................................................................................................. |
| Home phone.................................................
e-mail ..................................................... |
| Birth
date (D/M/Y)
............................................
Birthplace
.......................................... |
| Nationality
(your
passport
issued country)
.......................
Passport
number........................ |
Profession
.................................................
Are you
vegetarian
/ non-vegetarian?
......................... |
| Rafting
experience........................................................................................................ |
| Please
specify
if you have
any comments.................................................................... |
| ................................................................................................................................................. |
| ................................................................................................................................................ |
| ................................................................................................................................................ |
| SIGNATURE
.........................................................................
DATE ....................................... |
