Everest Base Camp

Registration Form

Note: Please be sure that the details below are exactly as they appear on your passport (passports need to be good for at least six months after the end of the trip and have some extra blank pages for visas).

PLEASE FILL OUT ALL THE INFORMATION BELOW

Personal Information :

Surname(Required)

First Name(Required)

Middle Name (If Applicable)

Date of Birth(Required)

Nationality(Required)

Passport Number(Required)

Passport Issue Date(Required)

Passport Expiration Date(Required)

Email(Required)

Phone Number(Required)

Home Address (Address, City, State, Zip Code)(Required)

Street Address Address Line 2 City State ZIP Code

Home Phone Number

Frequent Flier Number (Carrier and Number)

Emergency Contact 01

Name(Required)

Relation(Required)

Phone(Required)

Email(Required)

Emergency Contact 02

Name

Relation

Phone

Flight / Luggage Considerations

Plane/Flight Seat Preference

Luggage you will be traveling with, if known

T-Shirt Size

Dietary Considerations

Please describe any special Dietary considerations

Food Allergies

Health Considerations

Please describe any health considerations

Visa Requirements

Passport Picture(Required)

Max. file size: 1 GB.

Photo (Selfie)(Required)

Max. file size: 1 GB.

Registration Form

Registration Form

PLEASE FILL OUT ALL THE INFORMATION BELOW