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)*GenderMaleFemaleOccupation Trip DetailsTrip Date*Jan 26 – Feb 9Feb 9 – Feb 23Feb 23 – March 8OtherAre you flexible with dates?*YesNoEquipment Choice*SkiSnowboardTelemarkAbility*IntermediateAdvancedExpertHow would you rate your fitness?*PoorBelow AverageAverageAbove AverageVery FitHow long have you been skiing or boarding?*0 = 5 years6 - 10 years11 - 20 years> 20 yearsHow many days in the last three years?*0 - 1011 - 2526 - 5050 - 100> 100List places where you have skied/boardedAre you aware that Gulmarg is predominantly an off-piste resort? (i.e. very few, if any groomed runs)*YesNoBriefly outline your off-piste experience*Briefly outline your skiing/boarding background*Do you have any backcountry touring experience?*YesNoHave you skied or boarded at Gulmarg before?*YesNoAre you aware that to access or return from some of the best runs a 10 to 60 minute skin is sometimes required?*YesNoPlease add any information you feel is relevant to this application Equipment RequirementsAll Participants15 - 40 litre day pack with ski/board carrying capability*I will provideI will hireAvalanche Transceiver*I will provideI will hireShovel*I will provideI will hireProbe*I will provideI will hireAvalanche Airbag Pack (Recommended)I will provideI will hireSkiersSkis with touring bindings or telemark skisI will provideI will hireSki PolesI will provideI will hireClimbing SkinsI will provideI will hireSnowboardersSnow ShoesI will provideI will hireCollapsible PolesI will provideI will hire AccomodationAre you travelling solo or with friends?*SoloOne otherTwoThreeFourFiveFive plusPlease enter the name of your travelling companion(s) or a group nameWhat style of accommodation would you prefer?*TwinDoubleSingle ($950 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*YesNoIf yes, please provide detailsHave you ever had a heart attack or stroke?*YesNoIf 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?*YesNoDo you frequently suffer from severe motion sickness?*YesNoDo you have elipesy or experience seizures, fainting, dizziness, blackouts or fits of any nature?*YesNoDo you have any behavioural health, mental or psychological problems?YesNoDo you have any kidney disease?*YesNoDo you have diabetes?*YesNoDo you have any cancer or tumour of any nature?*YesNoDo you suffer from Asthma, persistent coughing or other lung disease?YesNoDo you have any sight impairment other than long or short-sightedness?*YesNoAre you pregnant or attempting to become pregnant?*YesNoAre you presently taking prescription medications?*YesNoIf yes, please provide detailsDo you have high blood pressure?*YesNoHave you every had any surgery including for the heart, lungs, back, upper or lower limbs?*YesNoIf yes, please provide detailsDo you suffer from haemophilia or any other blood disorder?*YesNoIf yes please provide detailsHave you had or do you suffer from ear disease or surgery, hearing loss or problems with balance?*YesNoAre you allergic to any medications?*YesNoIf 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.*YesNoUntitledI 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.*YesNoI understand that any misstatements, omissions or falsifications will cause for my Application to be disqualified.*YesNoI 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.*YesNoI 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.*YesNo This iframe contains the logic required to handle Ajax powered Gravity Forms.