REGISTRATION FORM FOR ENROLL2013
TOUR MEMBER INFORMATION
Full Name of Participant *
Are you a Skier or Snowboarder?
Skier Snowboarder
Please select a session
Gender*
Male Female
Date of Birth *
  
Phone:*
Current Address:*
City:*
Province/State:*
Postal/ZIP Code:*
Home Phone:*
Email:*
Passport Number:
Passport Issuing Country:
Family Doctor:
Health Card Number:
PARENTS/LEGAL GUARDIAN INFORMATION
Name:
Current Address:
City:
Province/State:
Postal/ZIP Code:
Home Phone:
Cell Phone:
Work Phone:
Email:
EMERGENCY CONTACT INFORMATION
(Check to use Parent/Guardian Information: )
Name:*
Relationship:*
Home Phone:*
Cell Phone:
Work Phone:
Email:*
Would you like to purchase the following additional items:
Travel Insurance
Premier Trip Cancellation, Interruption, Emergency Medical, Baggage & Personal Effects coverage from TIPS Youth Travel Insurance
$ 175
Clothing
Campers who come to Chile are required to purchase or rent an avalanche beacon. You can rent one from Evolve or purchase one on your own
$ 150
Cd/Pictures:
Compilation Picture Album of Camp 2013
$ 150
Enter Promotional code(if any):
 
You have two choice for payment for your tour:
Pay securely with your Visa/Mastercard .
Pay with Cheque. Please make cheque out to
Evolve Tours, 1759a Avenue Rd, Toronto On, M5M 3Y8
 
Acknowledgement
I have read and agree to the Terms and Conditions
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