Experience the Power of Everest Base Camp
May 2018
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Registration Form

Himalayan Trek to Everest's Base Camp

Join us on a 21-day Himalayan trek to Everest's Southern Face Base Camp through some of the world's most spectacular mountain scenery. Everest's daunting summit soars so high that trekking to its base camp is an adventure of the highest sort. It's not just a mountain, it's a dream.


  • 1: Registration
  • 2: Payment

Personal Information:

         
         

As it appears on Passport, including first, middle and last names
         
         

Contact Information:

Event Information:

Please create a password in order to collect donations from your friends and family online. You will also be able to view your donation/collection status and access additional information

None / Allergies / Prescriptions / Illness / Under Physician's Care / Other (please specify)
        
If you wish us to send a card acknowledging your dedication to the honoree or family of the deceased, please give us contact information in the space provided below:

Terms and Conditions:

I/we wish to participate in the British Friends of SHALVA everest Challenge, in order to raise awareness and critically needed funds that support the non-profit work of SHALVA.
I/we understand that while training for and participating in this event, I/we will be traversing public streets and thoroughfares where potential hazards exist.
I/we confirm that I/we am/are aware of and appreciate the risks that may result.
I/we am/are also aware that accidents may occur during this event or during the training for this event which could result in serious injury or death.
I/we am/are voluntarily participating in this event and in the training for this event with knowledge of the dangers involved and I/we agree to accept all risks of injury or death.

All participants undertake to meet their fundraising target and any shortfall in this amount will be debited from the credit card used to pay the deposit to SHALVA, two weeks prior to departure. Any further funds raised within a month of the end of the challenge, will then be reimbursed onto the card from which it was debited.

I/we am/are aware that if for any reason I/we am/are not able to participate in the event, I/we will still honor my/our obligation to raise the fundraising minimum established for the event.

I/we will be responsible for ensuring that all funds collected, whether cash or cheques, have been received by the local Shalva office on or before the fundraising deadline.

In consideration for being permitted to participate in this event in support of SHALVA, I/we agree to assume all risks and to release, hold harmless, and covenant not to sue SHALVA, the British, Canadian or American Friends of SHALVA, members of the event team, SHALVA coach or Trek Leader, and/or any designated beneficiaries, sponsors, officials, participating clubs, communities, organizations, friends of the event, including the event medical sponsor, the medical director, and members of the medical team, and all other government or public entities including, but not limited to, the Department of Transportation and affiliated organizations and all their respective directors, officers, agents, employees and members (collectively, "the releases"), from any claim, loss or liability that I/we may have arising out of my/our participation in and training for the event, including bodily injury, death or property damage, whether caused by negligence or carelessness of the releases or otherwise.

I/we agree to waive my/our rights and to discharge all the releases from all claims, losses, or liabilities for death, bodily injury or property damage that I/we may have, or which may hereafter accrue to me/us, as a result of my/our participation in this event, even though that liability may arise from negligence or carelessness on the part of the releases, from dangerous or defective property or equipment owned, maintained or controlled by them or because of the possible liability without fault. I/we understand and agree that the Waiver and Release is binding on my/our heirs, assigns and legal representatives.

I/we am/are physically capable of training for and completing this event. If I/we am/are aware of or under treatment for any physical infirmity, ailment or illness, my/our medical care provider knows of and has approved my/our training for and participation in this event. I/we will maintain personal health insurance while training for and participating in the event. I/we acknowledge that I/we and I/we alone am/are entirely responsible for my/our personal health and safety and the personal property I/we bring with me/us. 

I/we understand that all donations processed by SHALVA are non-refundable and non-transferable even if I/we do not participate in the event.

I/we understand that my/our name(s), photograph(s), voice(s) or likeness(es) may be used by SHALVA, Frieds of SHALVA, and their sponsors, beneficiaries, licensees, affiliates and employees. I/we consent to and authorize, in advance, such use and waive all rights of privacy I/we have in connection therewith. And I/we understand that I/we will not benefit financially from any use thereof. 

I/we have carefully read this Waiver and Release and fully understand its contents. I/we am/are aware that by accepting this Waiver and Release, I/we am/are waiving legal rights and knowing this, I/we accept it of my/our own free will.