Patagonia Mountain Agency Expedition Application, Pakistani Biodata Form:

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

ANNEXURE  'B'


PARTICULARS OF LEADER AND MEMBERS OF AN EXPEDITION PARTY


1. Name of member/leader:

   Mr./Mrs./Miss

2. Nationality:

3. Residential address:



4. Occupational address:



5. Date of birth:

6. Place of birth:

7. Passport number:

8. Date of issue of passport:

9. Place of issue of passport:

10. Most recent dates of visits to Pakistan with places. (For one year only):



11. Duties to be performed during climb:



Signature_____________________________

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