Name as it appears on your passport: *

First Name

Last Name

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone/internet/screen access *

I understand that I will be encouraged to un-plug for the duration of my Nepal Leadership experience (no phone, screen or internet access, you can use your camera).

Yes, I understand

Tour operator liability waiver *

I have personal travel insurance and understand that I am undertaking a Nepal Leadership Experience at my own risk.

Yes

We are using Charity Nepal Expeditions as our Tour operator. I understand that Katrina Webb is not responsible for any loss, theft, damage or personal injury that may occur during the Nepal Experience.

Yes, I understand

Print name *

First Name

Last Name

Date

MM

DD

YYYY