Aconcagua Expedition Mountain Guides

AVENTURAS PATAGONICAS TRIP APPLICATION

Expedition Sign-Up Form

Please fill out the information on the form below. If you wish to pay online with your credit card, you will be redirected to our secure payment form.

CONTACT INFORMATION

TRIP:

DATE OF TRIP:

NAME:

ADDRESS:

CITY:

STATE:

ZIP:

COUNTRY:

PHONE:

EMAIL:

IN CASE OF EMERGENCY NOTIFY

NAME:

ADDRESS:

CITY:

STATE:

ZIP:

COUNTRY:

PHONE:

PERSONAL INFORMATION

AGE:

HEIGHT:

WEIGHT:

OCCUPATION:

PASSPORT #:

ARE YOU A VEGETARIAN:

YES NO

DO YOU HAVE ALLERGIES (Including Food Allergies):

YES NO

If YES, please explain:

ARE YOU TAKING MEDICATION:

YES NO

If YES, please explain:

MEDICAL HISTORY:

OUTDOOR EXPERIENCE:

CLIMBING EXPERIENCE:
(Peak, Route, Date) - Please complete this if you are signing up for a mountaineering or skiing expedition. Send a separate email if necessary.

HOW DID YOU FIRST LEARN OF AVENTURAS PATAGONICAS:

ACONCAGUA EXPEDITIONS ONLY

SINGLE HOTEL OCCUPANCY SUPPLEMENT:

4 nights of single hotel occupancy: 2 nights at the Mendoza Park Hyatt, 2 in Penitentes and *single tent to Base Camp. ($500 added to cost of expedition due with final payment).

Check to select SINGLE SUPPLEMENT option.

NOTE: *Single supplement does NOT mean you will have single tent occupancy as it is non practical for our Guanacos/Ameghino Valley Expeditions since weight is a primarily issue from base camp up.
(for single supplement option for other expeditions please contact us)

DEPOSIT PAYMENT INFORMATION

METHOD:

Check Money Order Credit Card

NOTE: You will be redirected to our secure payment form after submitting this form. Information will be available on how to pay by check or money order on the payment form.

AVENTURAS PATAGONICAS
Toll Free: 888.203.9354 · International: 303.447.2858 · Fax: 303.417.0789
1303 Sumac Ave · Boulder, CO 80304 · USA · Send Us an Email

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Call us Toll Free from the UK -Toll Free: 0800 404 9183