Step 1 of 4 25% Personal DetailsName* First Last Pronouns* She/Her He/Him They/Them 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 FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCĂ´te d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRĂ©unionSaint BarthĂ©lemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTĂĽrkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweĂ…land 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 & PaymentTrip Date Selection*July 17-19, 2022Please select Training Program* Yes Interested No Thank You Are you interested in a training program to get ready for this adventure? Our training programs are with the adventure guide, leader and coach, Keri Bowzaylo. Please check yes if you are interested and Keri will communicate with you to get started. Trip Payment Policy*I agree to the trip payment policyOnce your registration form is submitted, an invoice for your trip deposit and remaining amount will be emailed to you. (This may take a few days to receive) You are able to make partial payments on the remaining balance. The full balance needs to be paid before 30 days from the trip start date. If you have not paid the remaining balance before 30 days of the trip start date then you are considered not coming and loose your spot on the trip. There are no refunds for any flight, activities, transportation or accommodations that have been booked and are holding your spot. If you have to cancel your trip for any reason there are no deposit refunds available. All permits booked are non refundable and non transferable as they are sold on an individual basis to your passport number. If you need to cancel your within 30 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. Total Trip Cost: CAD$565.00 Deposit: CAD$145.00 All Canadian Residents are charged GST 5% Tax. 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)Deposit - CAD$145.00* I agree and understand This deposit is non-refundable deposit of CAD$145.00. This deposit secures your spot for the chosen adventure date. You will be emailed an invoice shortly. Thank you so much!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 I want to get news and updates from Run Like a Girl! Δ
