Everest Panorama Trekking Trip Registration
PREREQUISITES and REQUIREMENTS FOR THIS TRIP:
1. Prior to completing this registration you MUST read the following detailed documents at www.CampBethelVirginia.org/nepal
- DETAILED TRIP ITENERARY
- NEPAL TRAVEL TIPS
- RECOMMENDED PACKING LIST

2. Prior to completing this registration you should have made (at minimum) your intital $800 deposit, $300 of which is non-refundable. Payment button is at www.CampBethelVirginia.org/nepal.

Upon SUBMITTING this Registration Form, Trip Leader Beth Wiegandt will contact you about the trip, and she will send you a required Participant Health Form.

Required information is marked with a red "*" asterisk.

Participant Authorization and Assumption of Risk Form: Do you agree to the Participant Authorization as described below? *
I have read all the trip information contained in the documents "DETAILED TRIP ITENERARY," "NEPAL TRAVEL TIPS", "RECOMMENDED PACKING LIST" and I understand and agree to all the information therein. I understand that I will be participating in physical activities (including, but not limited to those listed in the trip descriptions) and the potential for accidents exists. In consideration of acceptance into this trip. I indemnify and hold harmless Camp Bethel, the Virlina District Board–Church of the Brethren, Inc. and its staff, volunteers and officers from any and all liability, claims, damage, injury or illness sustained by me. I verify that the information on this Registration Form is correct and complete as far as I know. The information on this form may be printed and copied for camp records. I agree to the release of any records necessary for emergency purposes. I agree to read all information included in confirmation materials sent to me after registration and to share this information with my emergency contact person, and to read, sign and return any and all applicable forms and waivers. I permit photos, video and audio of activities or interviews that may include me to be used in camp/trip promotion without liability or remuneration.
Required
Your First Name *
Thank you for using correct capitalization throughout this form. Required info.
Your answer
Your Last Name *
Thank you for using correct capitalization throughout this form. Required info.
Your answer
Your Gender *
Required info.
Your Date of Birth *
Ex: 02/09/1981. Required info.
Your answer
Your Full Mailing Address *
Include Street or PO Box #, City, State and Zip. Thank you for using correct capitalization throughout this form. Required info.
Your answer
Your E-mail *
We will use this e-mail address to confirm your registration and communicate Course specifics. Required info.
Your answer
Your Cell Phone Number *
We will use this number to communicate Course specifics and/or important updates to our time together. Required info.
Your answer
Your Home Phone Number
In case we can't reach your cell phone, we will use this number to communicate Course specifics and/or important updates to our time together.
Your answer
Do you understand what your $2,300 fee does NOT include? *
I understand my trip fee does NOT include the following: My flight to and from Kathmandu (arrive October 11; depart October 20); Nepal Visa ($25 USD plus 2 passport photos); Meals not stated on the itinerary; Alcohol purchases with meals/other; Tea stops while trekking (nominal charges < $10USD each); Gratuity for drivers, porters, and guides; and any personal purchases. Information is included in the document, "2018 Everest Panorama Trekking Trip Info" (located at www.CampBethelVirginia.org/nepal)
Required
Do you understand what IS included in your $2,300 fee? *
I have read the document, "2018 Everest Panorama Trekking Trip Info" (located at www.CampBethelVirginia.org/nepal) and I understand what IS included in my fee.
Required
Do you understand the deposit amounts, deposit dates, and the refund policy? *
$2,300 per person: $800 deposit is due ASAP after January 2 and by August 1, of which $300 is non-refundable at any time and $500 is non-refundable after August 1. 2nd installment of $800 is due September 1, and $700 balance is due October 1. All deposits and payments count toward your total fee. NOTE: $300 of your $800 1st deposit is non-refundable, and $500 is only refundable up until August 1. NO REFUNDS AFTER AUGUST 1. (Trip insurance is strongly recommended.)
Required
Have you considered purchasing Trip Insurance from your preferred insurance carrier? (Recommended but not required.)
BECAUSE THERE ARE NO REFUNDS AFTER AUGUST 1, 2018, TRIP INSURANCE IS STRONGLY RECOMMENDED.
Have you read the detailed daily itenerary detailing the physical nature of this trip, and do you attest to your PHYSICAL ABILITY to participate? *
We encourage participants to consult your family’s primary care physician to assess your current health and physical abilities. I am physically able to participate in all aspects of this trip.
Required
Do you understand that this international trip requires a passport valid through at least April 20, 2019? *
Required
BE SURE TO CLICK THE "SUBMIT" BUTTON BELOW.
Your answer
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