ACROSS THE DIVIDE OPEN CHALLENGES
REGISTRATION FORM

Your registration for your chosen event implies acceptance of the Booking Conditions

Confirmation of your registration along with a participant event pack will be sent to you within 14 days of our receiving your application. If the trip is full or under the minimum group size, you will be offered an alternative event, or refunded your registration fee and travel insurance.

If you do not wish to book online, please download the forms and post them to:

    Across the Divide Limited
    Jubilee House
    Fore Street
    Thorncombe
    Nr Chard
    Somerset
    TA20 4PP
    UNITED KINGDOM

Fields with a * are compulsory

 

*I would like to take part in:

Personal Details

*Title:

*First Name:

*Surname:

*Occupation:

*Sex:

*Date of Birth:

*Home Address:

*Postcode:

*Daytime phone number:

Mobile phone number:

Evening phone number:

*Email address:

Passport Details

*Do you have a valid UK passport?

 

Name as it appears on the passport:

Passport number:

Nationality:

Place of issue:

Date of issue:

Date of expiry:

Country of residence:

Additional Details

Dietary requirements:

*T-shirt size (for charity use) :

*I am happy for my details to be circulated to other
fellow challengers on my event?


*Payment Options

Payment Option 1
I will pay the registration and insurance fee to sign up and secure my place on the trip and then pay the full tour cost 8 weeks prior to the trip. Then I’ll raise as much sponsorship money as possible for my charity and this can be done either before or after the trip.
 

 

Payment Option 2
I will pay the registration and insurance fee to sign up and secure my place on the trip. I will then raise a minimum level of sponsorship for my charity and in return my charity will pay the full tour cost directly to Across the Divide from the sponsorship money that I raise.



Charity Details

*I intend to support (charity name):

Registered charity number:

Charity phone number:

Charity address:

Contact name at charity:

*Contact email at charity:

Declaration

By clicking on submit, you agree to the following:

I have read and agree to abide by the Booking Conditions.

I agree to undertake to raise the minimum sponsorship required for my chosen destination.

I understand that all monies raised by me will be given to my chosen charity.

I understand that the event will involve strenuous activity and that I need to have obtained an adequate level of fitness prior to departure.

I will inform Across the Divide Expeditions of any changes to my medical form prior to departure.

I hereby certify that the information provided by me on these forms is to the best of my knowledge true and correct.

I understand that if any of the information provided by me on any of these forms is incorrect, I may forfeit my place on the event.

I am over 18 years of age at the date of departure.

*I have read and agree to abide by the Booking Conditions

 

 

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