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| Beneficiary: WhiteWater Nepal (P) Ltd. - Thamel – Kathmandu A/C No: 010100061440 Bankers: Bank of Kathmandu Ltd – Thamel Branch - Kathmandu - Nepal Telex No: 2820 BOK NP; Swift code: BOKLNPKA |
| I have applied to participate in (check trips applied for & single supplement option if desired)............. |
.......................................................................................with my personal information as follows: |
| Name (as in passport) ...................................................................................................................... |
| Street address .................................................................................................................................. |
| City, State, Zip .................................................................................................................................. |
| Home phone.................................................E-mail ........................................................................... |
| Birth date (D/M/Y) ............................................ Birthplace ................................................................ |
| Nationality (your passport issued country) ....................... Passport number...................................... |
| Profession .................................................Are you vegetarian / non-vegetarian? ........................... |
| Rafting experience............................................................................................................................ |
| Please specify if you have any comments......................................................................................... |
| ......................................................................................................................................................... |
| ......................................................................................................................................................... |
| ......................................................................................................................................................... |
| SIGNATURE ......................................................................... DATE ................................................... |
