Application Form

RoyalCollege of Psychiatrists Trek to Kerala

To Register

Please complete this form and return it to:

Liz Cowan

RoyalCollege of Psychiatrists

17 Belgrave Square
LondonSW1X 8PG

Tel: 0207 235 2351 ext 122Email:

Please read this form carefully. We advise taking a photocopy for your own records. Every person must fill in and sign their own registration form. When we receive your £200 non-refundable deposit we will confirm your place in writing and send fundraising and event details. The deposit does not include personal travel insurance. All tour and travel arrangements for this event are being booked through The Ultimate Travel Company (ATOL protected No 5111).

Personal Details

Please use capitals and write in black ink

Title (Dr/Mr/Mrs/Ms/Miss) Surname (as passport)

Forenames

Address

Postcode

Home Tel Work Tel

Mobile Email

Next of Kin

Name Relationship

Daytime TelEvening Tel

Dietary Requirements

Do you require vegetarian meals and/or have any other dietary requirements (e.g. food allergies)?

Passport details

Name as in PassportNationality

Passport No Date of Birth

Date and place of issue Date of expiry

If you do not have a passport at the moment, just send in your entry form and let us have the details as soon as you can. Your passport must be valid until 6 months after the end of the event.

Friends/Room sharing

Accommodation will be shared (both in the hotels and when camping - tents will each be for two people). If you would like to share a room and tent with a particular friend, please write their name

Insurance

It is your responsibility to organise your own personal travel insurance covering health, accidents and loss. Preferential Insurance is UTC’s recommended policy. They can be contacted by phoning 0870 600 7766 – please ensure you state you are trekking. You must have adequate insurance to take part in this event.

Medical Information(see separate form)

Trekkingis a strenuous activity and you should therefore, be reasonably fit and enjoy sufficient good health to participate in this trip.

If you are not a regular hiker, you should go out at least one weekend to practice

all-day trekking. It would also be helpful if you joined us on the practice trek in North Wales. Remember you could be hiking for up to eight hours a day over undulating terrain.

A fully trained, English speaking doctor will accompany the trek.

Enclosed is a medical form, which you must complete and return with this application. Your GP must sign this form if you tick any of the boxes or if you are over 65 years. It is important that your GP fully understands the nature of the challenge you will be undertaking. Until this form is completed and approved, we can not guarantee your participation in the trek.

It is essential that our medical personnel are fully briefed on every person participating, so we do need accurate and honest medical information. All medical information will be treated with confidentiality and if you have any concerns you would like to discuss with us prior to completing this form then please contact us.

Vaccinations

Typhoid and Hepatitis A vaccinations are advisable and we recommend that Tetanus and Polio boosters are up to date. You may also be advised by your GP to take anti-malarial protection. Further information will be included in the event pack you will receive once you have signed up.

Passports and Visas

Participants must have at least 6 months validity on their passports from the date of return to the UK. British passport holders will require an Indian Visa in advance of travel which are approx £30. Other nationalities should check with the Indian Embassy. Further information on applying for visas will be provided in the event pack once you have signed up.

I apply to take part in the RoyalCollege of Psychiatrists Overseas Trek and undertake to abide by the rules and conditions of this event (see next page).

I undertake to raise as much sponsorship to benefit the Royal College of Psychiatrists as is possible.

I enclose a cheque for £200 deposit (payable to Royal College of Psychiatrists). I understand this is non-refundable.

SignedDate

RoyalCollege of Psychiatrists Trek to Kerala

Terms and Conditions

  • A non-refundable registration fee of £200 is required to take part in the trek. You are also required to raise in sponsorship, or to pay, the minimum sum of £3,000. This sum of at least £3,000 must be paid tothe Royal College of Psychiatriststen weeks prior to departure (as this is when we pay for the cost of the trek).
  • If you are unable to meet the cost of £3,000, you may forfeit your place on the trek.
  • You must be aged between 18 and 70 before the departure date.
  • Your passport must have at least six months to run from date of entry.
  • All funds raised for Royal College of Psychiatrists through the event must be paid directly to them.
  • You must be covered by travel insurance for health, accident and loss.
  • All participants take part at their own risk.
  • For health and safety reasons the tour operator, ground agents and/or medical staff reserve the right to stop any participant from trekking.

Data Protection Statement

The College’s Data Protection Statement can be viewed at