Canmore Triple Summit Step 1 of 4 25% Personal DetailsName* First Last Gender* Female Male Other Birthdate* MM slash DD slash YYYY Email* Enter Email Confirm Email Phone number*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Continue to the next page to complete information on your fitness experience and medical details. How did you hear about this adventure? Facebook Instagram Twitter I have attended one of your other adventures and learnt about it while there A friend A friend who has been on one of your adventures RLAG website General web search Other Have you participated in any other retreats or Expedition Events?* Yes No If so what events or races have your participated in the past?Fitness ExperiencePlease select level of fitness*BasicIntermediateAdvancedPlease describe your regular physical activities.*Example: I walk 5-8 km twice a week, do bootcamp 3 times per week etc.Medical InformationDietary requirements/restrictions.*Do you have any pre-existing medical conditions or physical limitations that could affect your ability to fully participate in this active, adventure travel trip?*Include ALL medical conditions, disabilities, past surgeries (especially related to hip/knee replacements, joint injuries, cardiac, etc.), mental health issues and any other health concerns you think could be relevant to your participation in this trip.Medications*Please list all medications (prescribed and non-prescribed) you are taking, if any. Include dosage/frequency and condition being treated. If you aren't taking medications, please state that in this field.Do you have any known allergies?* Yes No If so, please list allergens, signs of reaction and describe the severity of your allergies.Are you required to carry an epi-pen?* Yes No Do you feel you have any psychological limitations?*EG: Fear of water, fear of heights, anxiety etc.Please tell us about your experience as a traveller and adventure lover.* Emergency Contact Name* First Last Emergency Contact Relationship* Emergency Contact Phone Number*Emergency Contact Email* Continue to the next page to select your dates and complete payment information.Dates & PaymentIn order to secure your spot for the Adventure Weekend, we ask that you select a date and submit a non-refundable deposit of $425.00 CAD per participant. Your deposit includes the processing fee of $12.00. If you are a Canadian Resident there is a 5% GST charge that will also be invoiced to you for your deposit and the invoices following. We only have 14 spots available in total per adventure retreat. Date Selection*July 19-22, 2020Trip Payment Policy*I agree to the trip payment policyAfter the initial deposit payment there will be one invoice to follow. The second invoice will be for CAD$1520.00, this needs to be paid 60 days before the trip. If you have not paid the second and final trip payment before 60 days of the trip start date then you are considered not coming and loose your spot on the trip. If you have to cancel your trip for any reason there are no refunds available. If you need to cancel your trip within 60 days of the trip date and have not paid the final trip payment you are responsible for paying the remaining amount owed for the trip. The total trip price is CAD$1895.00 Personal Travel Insurance* I understand and agree to have personal travel insurance for this trip Travel Insurance Run Like A Girl Adventures Inc requires travel insurance for all of our trip participants and we are partnered with World Nomads Travel Insurance. Travel insurance for independent travelers and intrepid families. You’d rather not think about all of the things that might go wrong on your trip, but these things can and do happen. Please check the box below to confirm that you will have travel insurance for this trip. Purchase Travel Insurance (Link opens in a new tab)Waiver Please click here to read our waiver and check the box below to agree. This is mandatory! (Link opens in a new tab)* I have read and agree to the above waiver Deposit* Price: $ 375.00 CAD Quantity: This deposit is non-refundable deposit of CAD$375.00 This deposit secures your spot for the chosen adventure date. You will be emailed a detailed itinerary shortly and a follow up invoice with the remaining payment amounts. Thank you so much.Total $ 0.00 CAD I want to get news and updates from Run Like a Girl!
