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Borneo's Wild Nepenthes 2011 Tour

To register for this tour please fill out the following form and click "Submit". You will be emailed shortly with payment details (payment is currently being accepted by credit card and Paypal). Registration is only valid after full payment has been received.

Registered participants will receive additional information on how to prepare for the trip.

Click here for trip details and itinerary (pdf document).

First Name
Last Name	Be sure your name is written EXACTLY as it appears in your passport.
Address
City
State/Province
Zip/Postcode
Country
Telephone
Email
Gender
Date of Birth
Passport No.
Nationality
	Medical Notes If you have any pre-existing medical conditions that may affect your ability to participate fully in this trip, please describe them here.
	Allergies (if any)
	Emergency Contact Name
	Emergency Contact Phone #
	Meal Restrictions (if any)
	If you have previously been mountain trekking in Borneo or elsewhere in Southeast Asia, please describe your experience here (optional).
	Questions or Comments

	Terms and Conditions 1. All participants will be required to sign a standard liability release form acknowledging awareness and acceptance of some risks during the trip. 2. Payment in full is required to secure your space on the trip. As seats on all flights are limited, please register early to insure your space. 3. The tour operator reserves the right to cancel the trip for any reason. In the event of trip cancellation the client will receive a full refund of all payments. 4. A deposit of RM 1000.00 must be made to secure your registration. This is non-refundable except in the case of trip cancellation. Full payment (balance RM 4600) is due by 10 September 2011.
	Tick this box if you have read and agree to the Terms and Conditions outlined above.