Application Form

Application Form

Today's Date

YYYY

Course/Trip Name

YOUR DETAILS

Name

As shown on passport

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Nationality

Date of Birth

YYYY

Age

Profession

Cell Phone with Country Code

Example: +44 555 675 3423

Alternate Phone with Country Code

Example: +47 555 67 342

Website

http://

EMERGENCY CONTACT DETAILS

Emergency Contact Name

First Name

Last Name

Relationship

Country

Cell Phone with Country Code

Example: +44 555 675 3423

Alternate Phone with Country Code

Example: +47 555 67 342

Email Address

YOUR EXPERIENCE

Please describe your cold weather experience and any issues you have ever had in the cold:

Describe your skiing experience.

While we are primarily interested in you cross-country skiing experience, tell us about alpine experience also.

Please describe your level of outdoors/adventure experience:

Please describe your level of fitness:

Why are you interested in undertaking this course/expedition?

Do you have any special food requirements?

By checking this box you are confirming that all the information in this form is true and correct

We respect the privacy of our clients. The information you provide will only be used for the purposes specified above and for our own internal statistics. Polar Expedition Training may keep your contact details on file for a reasonable period of time in case you wish to travel with us again. Please indicate if Polar Expedition Training may use your contact details for sending you our own information in the future. We will not pass your personal information to other companies or agencies.

Yes