Personal information( *: obligatory fields)
* Last Name
First name
Gender
M
F
Private Phone
* Email
Business Phone
* Address
Fax
* City
*Zip/Post Code
Country
Personal information of other interested participants
Registration Form
Selected hike
Code
Dates
From
Should this stay be
fully booked or the number of participants not enough :
Other hikee
Code
Dates
From
I
will arrive
For hiking tours via hotels (if
possible)
Room
Room for 1 couple(double bed)
Single room (extra charge)
Twin-beddedroom
Price
of the stay(for amounts in Euros, please use a dot
instead of a comma)
0
1
2
3
4
5
6
7
8
9
10
Pers. =
Possible
extra charges
INSURANCE COSTS
Cancellation
Insurance 2%
Or
Assistance, Repatriation, Cancellation Package Insurance 3%
Or
(You will receive from Pedibus a special
'discharge form' to be filled and returned).
TOTAL
AMOUNT
FF
Down
payment 30%
(rounding down to the closest hundred francs)
to the order of PEDIBUS
I have read and accepted the
terms of sale specified by PEDIBUS relating to this stay.
I remain absolutely aware that, during this stay, I may run a
number of risks inherent in the very essence of such stays (isolation,
remoteness of medical centres, dangers of mountain sports, etc.)
and I do accept those risks with full knowledge of the facts.
I undertake not to transfer the liability back to PEDIBUS, the
APRIAM, nor to local mountain guides or service providers. This
is used as a discharge paper also valid for entitled persons and
members of my family.
At :
Signature :
Once you have filled in this
form, printed and signed it, please return it together with your
payment.Availability for the selected hike will be confirmed by
E-mail and kept as an open option for 7 days until receipt of
payment.
STAGE 2:
Send the form and Print it out
