Apply to Join | KILIMANJARO FOR A CAUSE

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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

Tell us about you*

We use this info to make sure this is the right adventure for you. If your application is successful, we also use the information to introduce you to the rest of the tour group. Things you could include: what you do, things you are passionate about, what you are most excited for during the tour, something interesting/unique about you, etc.

Allergies, medical conditions or special requirements*

We can cater for most allergies and medical conditions. If you are concerned, please let us know so we can organise a time to discuss with you.

Emergency Contact*

First Name

Emergency Contact*

Last Name

Phone*

Phone

Email*

Shirt size*

Complimentary uni-sex travel shirt.

How did you hear about us*

Do you require assistance booking flights ($50 booking fee/flight)?

Discount code

Please enter your discount code.

Flights*

Travel insurance*

Payment options*

Deposit only

Pay adventure off in weekly/monthly instalments

Pay full fee now

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.*

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Our Terms & Conditions can be found below.

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Apply to Join | Kilimanjaro For A Cause

Terms & Conditions

Mandatory Medical Form

KILIMANJARO FOR A CAUSE

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