Trip Registration

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To begin, enter your E-mail address *

Next, we want to know the name of the trip you're signing up for*

Instructions:

Complete this form by checking or filling in each field. If you wish to mail you payment instead of using the pay online feature please note we must have your payment in certified funds no later than 15 days before the journey is scheduled to leave the departure point. Our address is below.

Your name *
Street Address *
Street Address
City *
State or Country *
Zip/ country code *
Home Phone Number *
Work Phone Number
Fax
Passport Number

Male     Female

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Smoking room     Nonsmoking Room 

Rooms are on a first come basis. You will be placed with a roommate in a double room unless you specify by clicking the box at the end of this text. We cannot guarentee a suitable roommate. Camping is two persons to a tent unless you specify otherwise. There may be a slightly higher cost for complete single accomodations. Please inquire by e-mailing us at Coordinator@XtremeXpeditions.net Single room

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Do you have camping equipment? Yes     No

Do you have camping experience? Yes     No

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Do you have a medical condition? Yes     No

If "YES" please explain...

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Do you have any other comments or questions?

I have read and completely agree with the terms and conditions page ( * your initials)

Welcome to the Expedition!       

       

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all rights reserved ~ all wrongs reversed

- You trip payment can be mailed to the folowing -
No personal checks please
Certified funds only

Jerry & Kathy Wills
Xpeditions Magazine
8367 W. Audrey Ln.
Peoria, AZ 85382

602 604 0212