Wild Trak Ultimate Adventure Application
Oh, why hello there adventurer. Wait a minute.  You must think you've got what it takes to go on Wild Trak's Ultimate Adventure!  

Well that's perfect because we are looking for adventurers as crazy as us to go search for some wild tigers.  Don't worry we'll keep you safe but that's really what this form is all about.  This trip is physically difficult and has inherent dangers for all of us, especially those who are inexperienced with trekking or wildlife.  So that's where this form comes in.  

Just read it.  Fill it out and then feel free to post a selfie of you on an adventure right on the Facebook event page.  Well okay maybe it shouldn't be a selfie, but there now, I've already said it and my backspace broke on the last expedition.

Please remit the refundable $500 USD deposit to paypal.me/LiveTravelTeach after filling out this form to be considered for a spot on the expedition today.  

More about the expedition and pricing can be found at https://www.facebook.com/events/1923380211314840/

*Note*
Submitting the application and deposit does not guarantee you spot on this expedition.  If you are not chosen or are unable to come on the expedition than your deposit will be refunded as per our refund guidelines.  Final payments must be completed one month before the start of the expedition.
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Last Name *
First name *
Email *
Age *
Gender
Phone Number
Don't forget a country code
Dietary Restrictions? *
Allergies? Food preference?
Tell us about your previous trekking experience.   *
What is the most consecutive nights you've been on a trek? *
9+
Have you had any serious injuries or surgeries? *
When?  What happened?
Do you currently take any medication *
Can you climb a tree? *
How often are you physically active? *
Hours per week + short explanation
Describe your fitness level *
Rate your fitness from 1 to 5
1 (Chris Farley)
2
3
4
5 (Husain Bolt)
Fitness
Have you ever felt the urge to climb UP a waterfall? *
Note* this question doesn't effect you eligibility*
Do you have any specific jungle interests?
Wildlife?  Plants?  Birds?  Geology? Insects?
Do you drink or smoke? *
Is there anything else you want to tell us?
Are you interested in the photography workshop?
$250 each or $400 for both
Deposit Info (Date, Issuing bank, Name on the account) *
If you haven't submitted your $500 deposit yet please write (NOT YET)
Referral Code
If you have a discount code please enter it here.
Submit
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