Make your own free website on Tripod.com
Home | Ladakh | Zanskar | Lahaul Spiti Kinnaur | Kullu Manali | Garhwal Kumaun | Photo Gallery | Testimonials | 2017 Dispatch | About us | Book a Trip | Contact Us

POTALA ADVENTURERS

(R) No. 2-15/97-KLU-TD-3611 by Department of Tourism H.P. India)

Bajogi. Vill Siyal, Manali – 175131, Himachal Pradesh, India

Tel: +91 1902 251705, Mob: +91 9816076854

Email: info@potala-himalaya.com

Booking Form

 

 

Please mail by post or through scanned email a copy of this Booking Form and Condition of Contract to POTALA ADVENTURERS with your signature. Use BLOCK CAPITAL throughout.

 

 


This is an agreement between POTALA ADVENTURERS hereafter called the organizer and following people called CLIENTS:

 

PERSONAL DETAILS

 

Title:                                       Mr. / Mrs. I Ms.

First Name:                           ________________________________________________________________

 

Last name:                            __________________________________________as it appeared on passport

 

Sex:                                        ______________________ Age ______________________________________

 

Name you like to be called: ________________________________________________________________

 

Home Address:                    ________________________________________________________________

 

                                                ________________________________________________________________

 

 

City, State, Zip, Pin code:   ________________________________________________________________

 

Nationality:                            ________________________________________________________________

 

Phone (H)                             _________________________ (W) _____________________________

 

Fax No.                                  __________________________

 

Email:                                    ________________________________________________________________

 

Occupation:                          ________________________________________________________________

 

Date of Birth:                        ________________________ Place of Birth:              ____________________________

 

Passport No                        ________________________________________________________________

 

Issue date                             ______________________________Expiry date_________________________

 

Place of Issue                      _______________________

 

Travel Insurance Name     ________________________________________________________________

 

 

 

 

Page 1/3

IMPORTANT

 

In Case of Emergency accident Please Notify Supplement Name Address of Person Whom You Know

 

 

First Name:                           _____________________ last name:           _______________________

 

Your relation:                        ___________________________________________________________

 

Address:                                                ____________________________________________________________

                                               

____________________________________________________________

 

Tel No:                                   ____________________________ Mobile No:          __________________

 

Fax No.:                                 ____________________________

 

Email:                                    ____________________________________________________________

 

TRIP DETAILS

 

Name of trip / trek:               _________________________________________________________

 

Leaving to trek on                ______________________ arriving at final destination on __________________

 

Thus comprising                 ___________ actual trekking days.

 

Guide Name                         ___________________________Horseman ____________________________

 

With ___________ horses. Or with porters ________________________

 

Arrival Date in New Delhi:

 

Date:                                      __________________________ From:        ________________________

 

Flight Name:                         ______________________

 

 

Departure Details from New Delhi:

 

Date:                                      __________________________ To                              ________________________

 

Flight Name:                         ____________________________________________________________

 

ADDITIONAL REQUIREMENTS

 

1. Are you Vegetarian / Non Vegetarian:                _____________________________

 

2. Allergic Health Problem if Any:                            _____________________________

 

 

_________________________________________________________________

 

Previous Trekking / Climbing Experience if Any:          ______________________________

 

______________________________________________________________________________________

 

 

 

 

Page 2/3

 

RELEASE OF LIABILITIES AND ASSUMPTION OF RISK

 

Please you must insure before commencing trekking, travelling, adventure travel, climbing, any sorts of adventure activities are not risk free. There is risk of Altitude sickness (AMS acute mountain sickness),

Where medical attention and evacuation may not be available in remote area, injury and death caused by falling rocks, avalanches, crevasses, while crossing high passes, miss-step falling, land-slides, weather may change to extreme conditions huge snow-fall, heavy rain, falling from temporary bridges, encounter with wild and domestic animal yak, Dzo, trekking horses/mules uncertainty caused injury.

These injury or accident are possible if you unaware of it however there are rare chances of injury cause guide and staff are there for your utmost safety all during the trek and tour.

 

1. I accept that agency will not be responsible for any accident that may occur during the trekking, or travelling.

2. I accept that agency will not be responsible for any loss of personal nature during the trip.

3. I accept responsibility for my own welfare any and all risks that may arise in connection with this trip.

4. I accept and acknowledge that I am voluntary participating on this adventure travel trip.

 

I understood and state that I have read carefully above given statement and safety while travelling, trekking or trek climb. Therefore I assume full responsibility of myself, any sorts of accidents injury, death or loss of personal belongings that occurs with me, POTALA ADVENTURERS, its owner and their staff, employees, associates, suppliers and affiliated companies, will not be responsible. I am fully in good physical condition and able to take part in this trekking tours organise by Potala adventurers. The term hereof shall serve as release assumption of risk for me, my heirs, administrators, and executors and for all members of my family.

 

I ACCEPT THE RELEASE OF LIABILITIES

 

SIGNATURE ______________________________________________________________________________________

 

 

 

I have carefully read this agreement and fully understand it’s contain. I am aware that this is a release of liabilities and contract between me and Mr. Prem Singh of Potala Adventurers and or his affiliated organizations and signs it of my own free will. I also acknowledge that I have carefully read Potala adventurers booking information and including its policy on cancelled trips and refund, and agree to all stated conditions set forth in the booking information.

 

 

 

Signature                              ______________________________________________________________

 

 

 

Witness                                  ______________________________________________________________

 

 

 

 

 

 

 

 

Page 3/3

 

........................................................................................................................................................................................................................................................................................................................................

           

           

tumblr hit counter

 

JOIN AND FOLLOW US

 

CONTACT US

 

OUR TOP PICKS-TRAVEL ADVENTURES

   
 

.
 
 
 
 
 
 

 

.                                  

 
 
Potala Adventurers
Bhajogi, H No 217, Siyal
Manali
Himachal Pradesh
175131
India

+91 1902 251705

+91 94593 43146

+91 78071 98706

Skype Me™!

skypotala

.                                  

Zanskar Dream Trek

 

.                                  

.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

- © 2003 - 2017 Potala adventurers - Best view in 1366 * 768 screen resolution -

.