I/We have carefully read and agree to all the conditions as stated under the heading "Terms & Conditions", especially noting the policy on cancellations and refunds. I/We have also carefully read the "Assumption of ALL Risks" and "Release of liability."

Please check the box above before submitting your application.

APPLICANT'S INFORMATION

Name (as it appears on passport):   Passport #:
Occupation: Professional/Technical Executive/Administrator Middle Management Sales/Marketing Clerical/Service Worker Tradesman/Machine Oper/Labor Retired Student Self Employeed/Business Owner   Other:
Nationality: White/Caucasian African-American Asian/Asian-American Latino/Hispanic Middle Eastern Native American Age: Sex: Male Female
Street Address:
City: State: AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY n/a
Phone: (home) (work)
Fax:
eMail:

IN CASE OF AN EMERGENCY, PLEASE NOTIFY:
Name: Relation:
Address:
Phone:

2ND APPLICANT'S INFORMATION (if applicable)

Name (as it appears on passport):   Passport #:
Occupation: Professional/Technical Executive/Administrator Middle Management Sales/Marketing Clerical or Service Worker Tradesman/Machine Oper/Labor Retired Student Self Employeed/Business Owner   Other:
Nationality: White/Caucasian African-American Asian/Asian-American Latino/Hispanic Middle Eastern Native American Age: Sex: Male Female
Street Address:
City: State: AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY n/a
Phone: (home) (work)
Fax:
eMail:

IN CASE OF AN EMERGENCY, PLEASE NOTIFY:
Name: Relation:
Address:
Phone:

I/We wish to book the following trek:
Dates

AIR TRANSPORTATION

All Image Quest Photographic Adventure Tours originate and terminate from Seattle, Washington. Tour members are expected to be in Seattle on the day of or prior to the departing flights to Alaska. Full flight itineraries will be sent upon acceptance of deposit. Image Quest Photographic Adventures can assist you in your flight reservations to help you insure that you will be at your destination in time for flight departures to Alaska.

Please arrange air transportation from :
and return to .

METHOD OF PAYMENT

I would like to use a credit card to pay for the following: airline tickets application deposit full Land Cost when due.

CREDIT CARD INFORMATION

Type of Card:American Express, MastercardVISA
Name as it appears on card:
Card Number: Expiration Date:

ACCOMODATIONS

Are willing to share a room with a Smoker Non-smokerEither .
Prefer a single/private room and are willing to pay the supplemental cost .

How did you hear of Image Quest Photographic Adventures? Please explain:

Please describe your health:

Please describe your photographic background: