Application Form

Today's Date *
Today's Date
YOUR DETAILS
Name *
Name
As shown on passport
Address *
Address
Date of Birth *
Date of Birth
Example: +44 555 675 3423
Example: +47 555 67 342
http://
EMERGENCY CONTACT DETAILS
Emergency Contact Name *
Emergency Contact Name
Example: +44 555 675 3423
Example: +47 555 67 342
YOUR EXPERIENCE
By checking this box you are confirming that all the information in this form is true and correct *
We respect the privacy of our clients. The information you provide will only be used for the purposes specified above and for our own internal statistics. Polar Expedition Training may keep your contact details on file for a reasonable period of time in case you wish to travel with us again. Please indicate if Polar Expedition Training may use your contact details for sending you our own information in the future. We will not pass your personal information to other companies or agencies. *