Gran Paradiso 4061m - 04/07 to 08/07 2025

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Climbing Experience and Aspirations

Please be specific with routes, grades and approx dates where possible.

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Medical History and Special Dietary Needs

Please list any relevant medical conditions that may affect your performance in the Mountains. Pre-existing medical conditions do not necessarily preclude you from participating in a course, but myself and my guides must be aware of them in order to plan realistic objectives or in case treatment is required.

Medical Conditions Please also include any allergies you have in this section and say exactly what you are allergic to.

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Course Applied For

Course:
Gran Paradiso 4061m

Dates:
04/07 to 08/07 2025

Deposit Due Now (€):
255

Balance Due 5/5/2025 (€):
1020

Personal Details

Name:

Passport No:

DoB:

Address:

Tel No:

Email:

NoK:

Medical History and Special Dietary Needs

Medical Conditions:

Special Dietary Requirements:

Climbing Experience and Aspirations

Rock Climbing:

Winter Climbing:

Alpine Mountaineering:

Aspirations for your course/trip:

Make Payment

Your application has been successfully submitted and your booking reference is Booking No . However, your booking will not be confirmed until you have made a payment of 255 Euros.

You may make this payment online by clicking on the Pay Now button below. If you cannot pay online you should contact me to arrange an alternative payment method.

Gran Paradiso 4061m - 04/07 to 08/07 2025

Personal Details

Contact Details

Next of Kin Details

Climbing Experience and Aspirations

Medical History and Special Dietary Needs

Data Protection

Check Application

Course Applied For

Personal Details

Medical History and Special Dietary Needs

Climbing Experience and Aspirations

Make Payment

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