Registration Step 2 of 3

This form is the second step to your registration.

Once you have submitted this section, please print out the NOTICE AND RELEASE form, and return to info@nahanniwild.com.

Once we have received your information, we will contact you to complete your registration.

PLEASE NOTE: Separate registration documents are required for each participant. 


Name *
Name
Address *
Address
Home Phone *
Home Phone
Work Phone
Work Phone
Date of Birth *
Date of Birth
Sex *
Emergency Contact
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Address
Emergency Contact Address
Emergency Contact Cell Phone *
Emergency Contact Cell Phone
Emergency Contact Home Phone
Emergency Contact Home Phone
Trip Cancellation and Extended Medical Insurance
We strongly recommend that you purchase additional insurance and that you review our cancellation policy. *
Medical Information
Please rate your health *
Please rate your own physical fitness *
Please rate your own swimming ability: *
If you are joining a RAFT trip, please indicate how much time you wish to spend in the inflatable kayaks:
Are you affected by any of the following *
Please bring duplicate prescriptions.
Your wilderness trip takes you through remote areas of Canada’s North. While your guides are trained in basic wilderness first aid, in case of a medical emergency, professional attention is not readily available. To the best of your knowledge, you agree that you are physically and mentally able to participate in the trip as described on our website. You must contact us with changes in your medical information prior to departure. *
Other Travel Info
Discounts
Please select the following that apply:
Additions
Please indicate if you will be sharing a tent with someone *
Equipment
(required for calculating aircraft payload)
(required for calculating aircraft payload)
We provide BARE 2mm Shorty Sport Wetsuites for all our participants. Please refer to their website for sizing information. www.baresports.com
Drink Preferences - We provide beer, wine, and soda with some evening meals. Special cold drinks - please check your preference:
Does your trip overlap any special dates? Please check: