Icetrek Expeditions. North and South Pole Adventures: Icetrek Expedition Registration

Expedition Registration of Interest

After reading the Booking Procedure, please complete the form below and submit.

We will contact you to finalise registration which includes completing and returning signed documentation and securing your place with a deposit of USD$/Euro 5000 or 10% of trip cost, whichever is greatest.

We will ask you to submit a resume of your experience

Please submit a Clothing Sizing if you have chosen our Polar Clothing Pack.

Given (first) Name/s: (as per passport)

Family (last) Name: (as per passport)

Gender:

Expedition Name:

Expedition Dates (d/m/y to d/m/y)

Your Nationality (as per passport):

Do you speak english?:

Primary spoken language:

Date of Birth (month)

Date of Birth (day)

Date of Birth (year)

Street Name:

City/Suburb:

Postcode/Zip:

Country: (as per passport)

Home Phone (include country and area codes):

Business Phone:

Mobile Phone:

Email address:

Passport Number:

Passport expiry date (month):

Passport expiry date (day):

Passport expiry date (year):

List any physical limitations:

How did you learn about icetrek?:

Emergency contact name:

Emergency contact phone number:

Cost of trip:

Currency

Do you require the optional US$2000/1500 Euro Clothing and Equipment Pack?

: All our trips are carbon neutral