Applicant's Name ________________________________

Address________________________________________

City___________________________________________

State _________________________ Zip _____________

Email _________________________________________

Telephone (Day)_________________________________

Telephone (Eve) _________________________________

Birth Date _____________________ Sex _____________

  ____Smoker             ____Non-Smoker

Occupation _____________________________________

Special Health or Dietary Concerns (any foods you especially dislike) _______________________________________________
_______________________________________________

IN CASE OF EMERGENCY PLEASE NOTIFY:

Name _________________________________________

Address________________________________________

City _____________________State_____ Zip_________

Telephone (Day)_________________________________

Telephone (Eve) _________________________________

How did you first learn of Wilderness Photography Expeditions?

__________________________________________________

RELEASE AND ASSUMPTION OF RISK
         I am aware that during the mountain tour, expedition, or other trip or vacation I am participating in under the arrangements of Wilderness Photography Expeditions and its agents and associates, certain risks and dangers may occur, including, but not limited to the hazards of traveling in mountainous terrain, illness or accident in remote places without medical facilities, the forces of nature, and travel by air, bus, automobile, or other means of transportation.
        In consideration of, and as part payment for, the right to participate in such mountain tours, expeditions and other activities and the food and services arranged for me by Wilderness Photography Expeditions, I have and do hereby assume all the above risks and will hold them harmless from any and all liability actions, causes of actions, claims, debts, and demands of every kind and nature whatsoever which I now have or which may arise in connection with my trip or participation in any other activities arranged for me by Wilderness Photography Expeditions and their agents or associates. The terms hereof shall serve as release and assumption of risk for my heirs, administrators and executors and for all members of my family, including any minor accompanying me.
        I have read and agree to these conditions.

Signature___________________________________________

Date_______________________________________________