BOOKING FORM Contact InformationFirst Name(Required) Last Name(Required) Gender(Required) Male Female Other Date of Birth(Required) DD slash MM slash YYYY Phone(Required)Email(Required) Nationality(Required) Occupation:(Required) Address of Residence(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Trip DetailsType of Trip Booked:(Required)Please select your Trip TypeMountaineering - Peak AscentsMountaineering - Private Instruction CoursesMountaineering - Technical ClimbsIce & Mixed ClimbingSki - Ski TouringSki - Ski Mountaineering / Steep SkiingAvalanche Skills Course 1Ski - Avalanche Skills Course 2Ski - TNF Ski CampsClimbing - Private Rock-Climbing CoursesClimbing - Multi-pitchClimbing - Alpine Rock AscentsPolar Expedition TrainingPhotoshoot or Film TripCustom TripPeak Ascent - Trip Selection:(Required)Please select your Peak AscentMt Aspiring - NW RidgeSingle ConeMt EarnslawMt BrewsterThe FootstoolAoraki / Mt CookMt Barff - Aspiring NPMt Barth - Ahuriri ValleyMt TyndallCustom AscentTechnical Climb - Trip Selection:(Required)Please select your Technical ClimbSouth Face - Single ConeNorth Buttress - Sabre PeakEast Face - Mt WalterCentral Gully South Face - Douglas PeakSW Ridge - Mt AspiringSouth Face - Mt AspiringSouth East Ridge - Mt DixonSouth Face - Mt HicksGrand Traverse - Aoraki/Mt CookCentral Buttress - Sheila Face - Aoraki/Mt CookEast Ridge - Aoraki/Mt CookNorth Buttress - Mt SeftonNorth Rib - Lendenfeld PeakAlpine Rock Ascent - Trip Selection:(Required)Please select your Alpine Rock AscentNorth East Ridge Single ConeGrand Traverse - The RemarkablesSharks Took PeakDasler PinnaclesMitre PeakMalte Brun - Bonney/West RidgeMalte Brun - North ButtressSabre Peak - North ButressTrip Dates(Required) DD/MM/YYYY for single day trip ; DD/MM to DD/MM YYYY for multi days trip Number of Days(Required)Please select from list1234567 and moreMultiple TripsCourse Date:(Required)Please Choose a course date:11th-12h July 202413th-14th July 202420th-21st July 2024Course Date:(Required)Please Choose a course date:7th - 10th July 2024 July 2024Extra Add-On Weather Day option ( +NZ$650 ):(Required)Please Select form listNoYes - 1 day prior the trip datesYes - 1 day after the trip datesYes - 1 day prior AND after the trip dates ( 2 days total )Yes - 2 days prior the trip datesYes - 2 days after the trip datesYes - 2 days prior AND after the trip dates ( 4 days total )Non-guided weather day option to secure the guide's availability prior and/or after the trip dates. Extra NZ$650/dayEmergency ContactFull Name(Required) Relationship to you:(Required) Phone(Required)Email(Required) Medical DataHeight in CM(Required)Weight in KG(Required)Any Allergies?(Required) Yes No Allergies(Required) Any medical conditions or previous injuries that could impact the trip?(Required) Yes No Medical Conditions / Previous Injuries(Required) Any dietary requirements?(Required) Yes No Dietary Requirements(Required) ExperienceFitness Level(Required) Casual Fit Gym Fit Hiking Fit Running Fit Trail Fit Crampons Skills(Required) No Experience Once or Twice - Beginner Regular practice on snow fields and glaciers Advance practice on steep snow slopes and mountaineering Expert practice on technical mountaineering and ice-climbing Rock-Climbing Level(Required) No Experience Beginner - Casual practice on Top-rope Intermediate - Regular practice on top-rope Advance - Regular practice on sport climbing lead up to grade au/nz 20 ; French 6a/b Expert - Lead sport-climbing mini grade au/nz 21-22 ; French 6b/c Skier or Snowboarder?(Required) Ski Snowboard Alpine Ski / Snowboarding Level(Required) Beginner -Ski on green/blue runs Intermediate - Ski on red runs Confident - Ski on black runs and all snow type Advance - Ski on all terrain and all snow type Expert - Freeride & steep skiing skilled Ski-Touring Experience(Required) No Experience Once or Twice - Beginner Regular practice every year - intermediate Regular practice every year - Advance Regular practice every year - Expert Number of ski / snowboarding days per year(Required)Number of ski-touring/split-boarding day per year(Required)Experience Description(Required)Additional InformationWhy did you book the trip?Any additional information? 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