Registered NO: 22742/059/060             
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FORMAL APPLICATION FORM

 
Program Name: Women Empowerment - Nepal
 

Instruction: Make sure that you have filled out the application completely before submission.  Please submit application with $199 non-refundable deposit that will be deducted from your total tour/trek fees.  However, the fee will be completely refunded if we fail to arrange you a tour/trek. No application will be considered valid if not accompanied by the deposit fee.  Once we receive deposit & application, we will reply within 24-48 hours. Moreover, please give us 2-3 days to do all process of your application, then we will immediately send you a notice of preliminary acceptance.
 

1.0 PERSONAL DETAILS:

First name:    Last name: 

      Middle:

Date of birth: MM/DD/YY

Place of birth:

Gender / Age:

Mailing address 1:

Passport number:

Date of issues:                                   Date of Expiry:

Nationality:

Home phone number ( incl. int’l code):

Mobile number ( incl. int’l code):

Other (specify):

E-mail address: 

2.0 IN CASE OF EMERGENCY NOTIFY TO:

Full Name:

Relationship:

Home phone number ( incl. int’l code):

Mobile: 

E-mail address:  

Other ( specify):

3.0 ACADEMIC BACKGROUND: ( Colleges & Universities only)

 

 

4.0 Are you interested in taking the one week ORIENTATION & CULTURAL Program?    Yes      No

5.0 Are you mentally and physically in good health for travelling ?
(Please list if you have any allergies, medication etc)


6.0 Explain your motivations to participate in Asia Horizon Tours/Treks:






7.0 Please explain your experience with developing countries. Have you ever experienced life beyond your comfort zone?



8.0 If you have any question or concerns, please write them here.





9.0 Do you want to help us as a reference person for upcoming travelers?  Yes    No

I hereby declare that everything in this form in true to my knowledge. I confirm that I have no other obligations, which might interfere with my participation in the Asia Horizon Tours/Treks. I also agree on all terms and conditions given by Asia Horizon, including the organization’s responsibilities, my responsibilities, my liability waiver, and the termination of my trip.


Signature: Date: