Apply to Join | Cambodia For A Cause

Apply to Join | Cambodia

If you are human, leave this field blank.

Select a date

Travel experience

Gender*

Personal details (as per passport)*

First Name

Last*

Last Name

Preferred*

Nickname

Passport number*

Passport number

Nationality*

Nationality

Place of birth*

Place of birth

Issue date*

Issue date (dd/mm/yyyy)

Expiry date*

Expiry date (dd/mm/yyyy)

Date of birth*

Date of birth (dd/mm/yyyy)

Phone*

Phone

Email*

Address*

Street

Suburb*

Suburb

State*

State

Country*

Country

Postcode*

Postcode

Allergies, medical conditions or special requirements*

Please advise us if you would like us to call you to discuss.

Emergency Contact*

First Name

Emergency Contact*

Last Name

Phone*

Phone

Email*

Shirt size*

Complimentary yoga or travel shirt.

How did you hear about us*

Flights*

Travel insurance*

Yes (I need help booking)

Fundraise for charity?*

Yes

Fundraising is not mandatory but it is recommended. All funds raised go to supporting the salaries of the teachers at the charity school we visit who currently do not get paid well. By supporting their salaries you will be empowering young Cambodian students by keeping them in school. You will also be enhancing your travel experience and feel great when you see the difference you have made. Tax deductibility is available if in Australia.

I want to add:

Single Supplement ($200)

Payment options*

Deposit only

Full fee

Pay adventure off in weekly/monthly installments

Upon receipt of your registration form, we will send you an invoice that includes payment options and directions for payment. Minimum deposit is 10% of total fee.

I acknowledge that the information supplied on this registration form was supplied by me, is true and accurate and if under 18 years was provided in the presence of and with the approval of my parent/guardian. By paying my adventure deposit, I acknowledge that I have read Adventure Out Loud's Terms & Conditions and that I agree to be bound by these terms and conditions.*

Agree

Disagree (please contact me to discuss)

Our Terms & Conditions can be found below.

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Terms & conditions

Mandatory medical form

Apply to Join | Cambodia

KILIMANJARO FOR A CAUSE

KEN-YA YOGA?

SAFARI NINJA

LUXURY SAFARI