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Trip booking
2009/2010 - Fixed Departure Trips
Home
» Bokking Form
B O O K I N G - F O R M
Name
*
as appear on the Passport
Date of Birth
*
Sex
*
M
F
Passport Number
*
Country
*
Occupation
*
E-mail address
*
Phone with countrycode
*
Phone1 ( Mobile/residence)
Emergency contact information if incase
Name
Tel
email
Relation
Do you have any medical conditions we should be aware of?
Yes/No, if yes, explain please:
Medical / Rescue insurance
Name of Insurance Company
Hot line telephone No
Kathmandu arrival date, time and flight
Departure date from Kathmand:
© 2005 - 2009 ECO TREK International, P.O. Box: 19538, Kathmandu
, Nepal
Tel : 977- 1- 4 4 24 113 / 20 90 369, Fax : 977-1-4358118,
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