
RACE REGISTRATION FORM 
 
E-mail   
 
Title -   Mr.    Ms.    Mrs. 
 
First Name            Last Name 
 
 
Complete Postal Mailing Address (with Postal Code & Country) 
 
 
 
 
Phone             Fax   
 
Occupation               Marital Status  
 
Emergency -           Name          Email         Phone No 
Contact                        
 
 
Select Trip - 
 
Stage Race          Mt. Everest Challenge Marathon (4 day trip)   Mt. Everest Bike Rally 
   
I am a                   Runner     Walker      Cyclist 
 
T- Shirt Size      Small      Medium       Large      X-large 
 
Smoker     Yes       No 
 
Room Sharing Preference   
 
Passport Details 
 
Exact name as it appears  
 
 
 
Number                Date Issued      Where Issued          Date Expires 
 
 
 
Date of Birth                   Age           Place of Birth      Citizen of 
 
 
 
See Booking Conditions for all the trips 
 
I agree to all booking terms & conditions  
 
 
Signature  ___________________________________ 
  (Please sign printed form before mailing)