Trip Reservation Form

Trip Name and Departure

Trip Name
Trip Date(s)

Please refer to the trip itinerary for trip costs, payment/refund terms and a description of the itinerary and what is included in the price.

Deposit Payment Methodology (Please indicate which applies for you)

By check in U.S. Dollars
Credit card through PayPal (final payment for multi-day trips is payable by check)

Room Type (do not complete for day trips):

Would you like a single or a double room?
If a double room, what bed type would you prefer: separate beds or a queen/king bed?
If double, who is your roommate?
Would you like Bredeson Outdoor Adventures to identify a room mate for you if possible?

Traveler Information:

First name
Last name
Date of birth
Nationality (country noted on your passport)
Address
Email address
Home phone
Work phone
Mobile phone
International mobile or Skype address (non-U.S. trips only)
Emergency contact not on trip with you (name, relationship, telephone)
Weight and height
Gender
Do you have any special dietary needs or foods you do not eat?
Please list any physical limitations or conditions, medications being taken, allergies, health problems, previous injuries.
Would you like to celebrate a special occasion on this trip? Comments?
Do you have first aid or CPR training?
What types of physical activity do you currently engage in regularly? How many times per week and for how long?
Please describe your hiking experience.*
What types of hiking do you currently engage in? (location, miles, mileage gain/losses, terrain)*

*Note: For snowshoeing, cross country skiing, or bicycling trips please provide your experience for the applicable sport for the last two questions and note the relevant sportin your reply.

Please forward, along with your Release of Liability Form and $500 deposit (multi-day trips) or full fee (day trips), to:

Bredeson Outdoor Adventures

Attention: Deborah Lewis

14 Cliffview Drive

Norwalk, CT06850

U.S.A.

Please make checks payable to “The Bredeson Group LLC.” You may also fax your forms to us at 1-203-849-7581, or email them to us at . If you wish to email your Release of Liability Form please make sure to sign a hard copy of the form first, scan it and then email it to us. Thank you.