Fill out and send us the following form below or print and send any other documents by fax to 56-2-2174684 This is part of the first step in registering for a KL Expeditions departure

This will help us to get acquainted with you. To enroll to climb any peak with us, fill out the:
(1) Trip Application
(2) Expedition questionnaire
(3) Do It Yourself (DIY) Medform.

Along with these 3 forms you must also send a non refundable $700 US $ deposit.

Once enrolled, you will receive an acceptance package. This package will include the following: An acceptance letter, a detailed equipment list, a medical release form, to be filled out by your physician, a detailed training program, all of our pertinent contact information, along with all other necessary information regarding your individual expedition.

Select Program Routes a Aconcagua ExpeditionsExpeditions a Other ExpeditionsPatagonia & Atacama Treks a Treks
With Private Porters		Without Private Porters
Other

Full Name	Mr: Mrs: Miss:
Address
City
State
ZIP / Code Postal
Country
Phone Home
Phone Mobile
Phone Work
E-mail
Ocupations
Passport Nº
Issue date
Expire date
Citizenship
Age
Date of birth
Height	Height Centimeters Inches
Weight	Weight Kilos Pounds
Shoe Size	Shoe Size USA Japan European UK
Blood group / Rhesus factor

	Please specified clearly year, mountain, route, altitude achieve, company & guide with who did you participate.

Diet Special Requirement	Yes	No
Single Room Hotel Reservation	Yes	No
	Note: Single supplement concern ONLY hotel booking and NOT the single tent use during the expedition & trekking program. Please contact us in case you desire a single tent supplement all time.
Climbing Equipment Rentals	Yes	No

		Product	Us $
		Tents: North Face - Mountain Hardware  Marmot	150
		Climbing boots Salomon double shell	140
		Expeditions Down Parka (Mountain Hardware)	120
		Internal frame Backpack (6000 + cubic inches or 90 liters)	100
		Down sleeping bag -26 degrees C with silk liner	140
		Gaiters	20
		Ice axe and leash 60 -70 cm	50
		Crampons compatible with your boots	50
		Tents: North Face - Mountain Hardware  Marmot	150
		Harness	30
		Trekking adjustable ski poles	50
		Expeditions down Mittens	50
		Ski Goggles	25
		Duffel bags (120+ liters)	25

KL Expeditions strongly recommends that you sign up for a Global Rescue membership for the length of your trip. Global Rescue is a medical evacuation provider that is capable of rescuing you from our remote locations and bringing you back to your home country hospital of choice. Their phones are staffed 24/7 by paramedics which are backed by over 2400 specialists from Johns Hopkins Medicine. For more information and to receive a 10% discount upon signing up, visit www.globalrescue.com/kl.

Attached find the amount of
Deposit US$
Payment Method
Credit Card	Visa	Master	Amex
Credit Card #
Expire
Check to KL EXPEDITIONS LTDA
Mailing Address Augusto Mira Fernández # 14248 CP 7591409 - Las Condes - Santiago - Chile. Wire transfer to Bank: WELLS FARGO BANK, NA Details will be send by e-mail