travel@mountainsinmind.com
Mountains In Mind
Home
Who we are
Where We Go
Booking Form
Testimonials
Blog
Contact Us
travel@mountainsinmind.com
Booking form
Booking Form
If you are human, leave this field blank.
Please select your trip from the drop down menu.
*
Toubkal Winter Adventure Thursday 16th March 2023 - Monday 20th March 2023
Kilimanjaro Saturday 17th September 2023 - Lemosho Route
Title
*
Mrs
Ms
Miss
Mr
Dr
Prof.
Rev
Hon
Sir
Full name (as it appears on your passport)
*
Personal details
Home address and postcode
*
Trip details
Prefered payment method
*
Deposit only
Full payment at time of booking
Monthly instalment payment plan
Three instalment payment plan
Credit charges apply
Date of birth
*
Email address
*
Mobile phone number
*
Passport number
*
Nationality (as on passport)
*
Passport place of issue
*
Passport issue date
*
Passport expiry date
*
Dietary requirements
*
Vegetarian
Vegan
Gluten free
Meat
Other
Dietary requirements
Next of kin details
The next of kin identified here should not be travelling with you.
Next of kin name (not on the trip)
*
Next of kin phone number
*
Including area and country code
Next of kin address and postcode
*
Medical details
Insurance details (policy number, company name, contact number)
We accept that insurance details may not be available at the time of booking but must be supplied four weeks prior to departure. Please ensure that appropriate high altitude trekking insurance is obtained with helicopter evacuation.
Medical conditions (medical conditions, injuries, disabilities, prescribed medication)
*
Due to the nature of our trips, all past and current medical conditions must be declared. This will enable us to be aware of any potential issues whilst trekking in remote areas, where medical facilities may not readily available.
Provide current fitness activities undertaken
*
Examples include running 5 miles twice a week, gym sessions four times a week, hill walking at weekends, cycling ten miles per day or currently not undertaking any activity.
Provide previous trekking, hiking, mountaineering and travel experience
*
Declaration
All information supplied on this form has been completed to the best of my knowledge.
*
Yes
I agree that I'm aware that all adventure travel and trekking carries a risk of injury and in extreme cases death. I am still happy to proceed.
*
Yes
I can confirm that I have read and agree with the the terms and conditions
*
Yes
Terms and conditions
×
How can I help you?