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Are you a citizen or Legal resident of this country?
Citizen
Legal Resident
Personal information
Last Name:
First Name:
Gender:
Male Female
E-mail:
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Street:
Number:
Employer:
Function:
More information about YOU
Date of birth:
Marital Status:
Children?
Yes No
Do you hold or are able to obtain a full passport valid for October or November 2010?
Yes No
Are you aware of any restrictions that would prevent you from obtaining a travel visa, if necessary?
Yes No
Are you available to attend all group trainings that will take place between March and June 2010?
Yes
No
Are you available to travel for 12 days at any time in October or November 2010 for the Expedition?
Yes
No
Do you have any objection to flying, especially in helicopters or small planes?
Yes
No
Information about your physical abilities
What is your level of fitness?
Low
Medium
High
Length (cm):
Weight (kg):
Have you had any health problems or received any medical treatment in the past three years?
Yes
No
If yes, please describe in detail:
Do you have any medical conditions: allergies: disabilities or take any medications?
Yes
No
If yes, please describe in detail (including the treatment for these):
Please list the sports / fitness activities you participate in on a regular basis. Please also state how often you participate in each. For example: occasionally, weekly, monthly):
Expedition
What other climbing or trekking experience do you have that might be relevant to your application?
What does Expedition mean to you?
What is the most adventurous thing you have ever done?
Why do you like climbing?
Describe your most favourite climbing moment
Describe your personality
Why do you want to take part in the Beyond Limits Expedition?
What would be your added value for the Team?
Any other information about YOU, you’d like to share with us?
Type the words you see in the image below: