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Reservation & Information Form


TRAVELER 1 

TRAVELER 2

Name (1):  Name (2): 
(As appears on passport)  (As appears on passport)
Street Address: Street Address:
City: City:
State: Zip: State:

Zip:

Home Phone: Home Phone:
Work Phone: Work Phone: 
Fax Number: Fax Number:
Sex : Male Female Sex Male  Female
Date of Birth : Date of Birth :
Passport No: Passport No:
Nationality:  Nationality:
Occupation: Occupation: 
Smoker Yes  No No Smoker Yes  No
Vegetarian Yes  No Vegetarian Yes  No
I am Traveling Alone Yes  No
(Single accommodations may be available at extra cost. Single travelers for whom roommates are not available are subject to a single supplement surcharge)

PERSON TO BE NOTIFIED IN CASE OF AN EMERGENCY
Name: Telephone No:
Address:
City: State:
Zip: Relationship:
Comment :

         


Please return to Journeys Mountaineering & Trekking - PO Box 8022, Kathmandu, Nepal
Telephone No: 977-1-4414662, 4419808   Fax No: 977-1-4415092
email: journeys@mos.com.np

Contact Addresses:
Country Tel E-mail Address Fax URL

Nepal

 +977-1-4414662 / 4419808 journeys@mos.com.np 977-1-4415092 http://www.journeys-nepal.com

USA

 734-665-4407 pat@journeys-intl.com 734-665-2945 http://www.journeys-intl.com

Israel

 +972-3-5467070 kfirtrvl@netvision.net.il +972-3-5467172

Latvia

 +371-7323099 mudite@impro.lv +371-7323360 http://www.impro.lv