Personal DetailsPlease allow approximately 15-20 minutes to complete this form. Booking Application Step 1 of 6 - Personal Details 0% Personal DetailsGiven Name*Last Name*Phone (including country code)*Email Address* Street*City/Town*State/Province*Country*Postal/Zip Code*Date of Birth (dd/mm/yyyy)*Gender Male Female Other Occupation Trip DetailsTrip Date*Jan 24 – Feb 5Feb 5 – Feb 17Feb 17 – March 1OtherAre you flexible with dates?* Yes No Equipment Choice* Ski Snowboard Telemark Ability* Intermediate Advanced Expert How would you rate your fitness?* Poor Below Average Average Above Average Very Fit How long have you been skiing or boarding?* 0 = 5 years 6 - 10 years 11 - 20 years > 20 years How many days in the last three years?* 0 - 10 11 - 25 26 - 50 50 - 100 > 100 List places where you have skied/boardedAre you aware that Gulmarg is predominantly an off-piste resort? (i.e. very few, if any groomed runs)* Yes No Briefly outline your off-piste experience*Briefly outline your skiing/boarding background*Do you have any backcountry touring experience?* Yes No Have you skied or boarded at Gulmarg before?* Yes No Are you aware that to access or return from some of the best runs a 10 to 60 minute skin is sometimes required?* Yes No Please add any information you feel is relevant to this application Equipment RequirementsAll Participants15 - 40 litre day pack with ski/board carrying capability* I will provide I will hire Avalanche Transceiver* I will provide I will hire Shovel* I will provide I will hire Probe* I will provide I will hire Avalanche Airbag Pack (Recommended)* I will provide I will hire I will not require SkiersSkis with touring bindings or telemark skis I will provide I will hire Ski Poles I will provide I will hire Climbing Skins I will provide I will hire SnowboardersSplit Board I will provide I will hire Collapsible Poles I will provide I will hire AccomodationAre you travelling solo or with friends?* Solo One other Two Three Four Five Five plus Please enter the name of your travelling companion(s) or a group nameWhat style of accommodation would you prefer?* Twin Double Single ($1,900 surcharge) Medical DetailsHave you experienced significant health problems, surgery or a change in your health status over the last year?*Do you experience any severe allergic reactions* Yes No If yes, please provide detailsHave you ever had a heart attack or stroke?* Yes No If yes, please provide detailsDo you have any musculoskeletal conditions? Arthritis Do you have any musculoskeletal conditions Gout Problems Neck, shoulder, back, hip, knee or ankle pain Recurrent problems, such as back problems Whiplash or other injury from a motor vehicle accident Repetitive strain of any nature Other (Please provide details below) Please provide other detailsAre you currently undergoing physical therapy?* Yes No Do you frequently suffer from severe motion sickness?* Yes No Do you have elipesy or experience seizures, fainting, dizziness, blackouts or fits of any nature?* Yes No Do you have any behavioural health, mental or psychological problems? Yes No Do you have any kidney disease?* Yes No Do you have diabetes?* Yes No Do you have any cancer or tumour of any nature?* Yes No Do you suffer from Asthma, persistent coughing or other lung disease? Yes No Do you have any sight impairment other than long or short-sightedness?* Yes No Are you pregnant or attempting to become pregnant?* Yes No Are you presently taking prescription medications?* Yes No If yes, please provide detailsDo you have high blood pressure?* Yes No Have you every had any surgery including for the heart, lungs, back, upper or lower limbs?* Yes No If yes, please provide detailsDo you suffer from haemophilia or any other blood disorder?* Yes No If yes please provide detailsHave you had or do you suffer from ear disease or surgery, hearing loss or problems with balance?* Yes No Are you allergic to any medications?* Yes No If yes, please provide detailsDo you have any transmittable diseases (including HIV and Hepatitis C)* DeclarationPlease read the following before accepting.I declare that I have reviewed this questionnaire carefully for completeness and accuracy prior to admission to Bills Trips.* Yes No UntitledI declare and certify all statements made by me in this form are true and correct and that I have not wilfully suppressed any material facts.* Yes No I understand that any misstatements, omissions or falsifications will cause for my Application to be disqualified.* Yes No I acknowledge that I must advise Bills Trips immediately of any change to my medical or fitness status between the dates of completing this medical questionnaire and departure.* Yes No I understand that a positive response to the medical questions or any change in my medical or fitness status does not necessarily disqualify me from participation in Bill's Trips.* Yes No
