Please complete this form and forward it with your deposit to the address listed above.

Name(s):___________________________________________________

Address:___________________________________________________

City:__________Prov./State:_________Postal/Zip Code:__________

Phone: (Home)____________________(Bus.)______________________

Fax:________________________ E-mail:________________________

Trip:_______________________ Date:_________________________

Are there any health or dietary concerns of which we should be aware?

___________________________________________________________

Allergies:__________________________________________________

Do you have any prior experience dogsledding, hiking or canoeing? __________________________________________________________

Gender: M F Age:_____ Weight: ____ Height: _____ Shoe size: ____

How did you learn about Uncommon Journeys?:

___________________________________________________________

Cost of trip: $_________ Find enclosed $_________ Deposit (25%)

GST (7%): $_________ 3.5% GST for non-Canadians: $________

Total: $_________

Final Payment Due: $_________

cheque enclosed____ money order____ direct deposit____

I have read and agree to the conditions as stated under "General Information".

Signature:_____________________________ Date:_____________