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Print this form and fill it out. Mail or fax to:
Patagonia Mountain Agency
P.O. Box 210516
Auke Bay, AK 99821
Call/Fax 907-789-1960
Web: www.alaska.net/~ptgmtnag/
email: ptgmtnag@alaska.net


                             PATAGONIA MOUNTAIN AGENCY
                              EXPEDITION APPLICATION


Expedition:______________________________   Dates:_____________________________

Name: ________________________________________ Age:_____ Ht.:______ Wt.:_______

Address:_______________________________________________________________________

City:_____________________________________

State:_________________________	Zip Code:__________   Country:_________________

In case of emergency contact (name & phone #): ________________________________

Occupation:____________________________________________________________________

Please list any medical conditions you have (include any medications that you 
are taking, as well as allergies): ____________________________________________
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Outdoor Experience: List type of trip & duration: _____________________________
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Climbing Experience: __________________________________________________________
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__________________________________________ Highest altitude achieved: _________

Have you done any of the following? ___Traveled on a Glacier, ___Winter Camped,
___Rock Climbed, ___Ice Climbed, ___Belayed, ___Used Ascenders, 
___Used Crampons, ___Used Ice Axe.

Do you have a training routine and for how long? Explain? _____________________
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List activities you are involved in on regular basis (hiking, skiing, climbing,
 running, etc.):_______________________________________________________________
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Nepali Biodata Form

Pakistani Biodata Form



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