Cape To Cape Track - Booking Form

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To book this trip, simply fill in this booking form. Once you have completed the booking form, please print it out and fax it or post it to the following address along with a $200 deposit:

ENVIRONMENTAL ENCOUNTERS AUSTRALIA
Suite B8, 550 Canning Highway
Attadale 6156
Western Australia
AUSTRALIA

Fax: (08) 9330 6077

International Fax: (61-8) 9330 6077

If you would like us to post you a booking form, please contact Tom & Sylvia

Trip Name: WALKING THE CAPES

Date: 8th - 15th November 2009

First Name:
Last Name:
Address:
Telephone:
Mobile:
Email Address:
Emergency Contact Name & Phone Number During Expedition:

Do you have any medical cautions the expedition leader should be
made aware of? (eg: medication, allergies, existing conditions, previous injuries)

Do you have any special dietary requirements?
(Our food is generally low fat, low salt, high carbohydrate with lots of fruit & vegetables. Although we endeavour to supply all you need, you are advised to provide any special personal requirements ie. herbal teas, non-gluten and non-dairy alternatives, etc.) Please contact us.

Accommodation:

Double? Travelling with? .....................................................................

Share single: Travelling with? .............................................................

I understand that there are risks inherent in outdoor activities and that on this program, these activities are to be conducted in remote wilderness areas with minimal medical and other facilities. By performing the activity, the client accepts the risk of injury notwithstanding service of this risk warning. The closest ambulance and hospital facilities are in Busselton and Margaret River. Evacuation will be at my own cost and I have considered travel, medical and ambulance Insurance cover.

Signed: ..............................................................................................................

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