Application Form for Participation in
"STIKAGE"
Adventure Programms

You may copy this form, fill it, enclose your payment and send it to our following postal address

To,
The Manager

STIKAGE (Adventure Tourism Wing)
7-UB, Jawahar Nagar-Kamla Nagar,
Delhi-110007 India
Phone: 91 11 23850036, 23850026
Telefax: 91 11 23850026
Email- stikage@yahoo.com
Website- http://www.stikage.com
Attach your 2 photo here

Sir, I We would like to participate in
program starting from To


Name in Block Letters: Father's name:
Sex: Age: Email:
Your Occupation:
Your postal address and contact phone numbers :
Previous experience of similar activities, if any. (Attach a separate sheets if needed):
Next of Kin (Relationship, Name and Address):

I agree to adhere strictly to the discipline of the program and abide by the directions of the organizers at all times during the program.

In case of any accident, illness or injury, I will not hold the organizers "STIKAGE", co-organizers or its staff responsible in any way. I declare that I do not have any infectious disease and I am keeping good health.

I will return the equipment / articles issued by the organizers for the above program with in the time period informed by them. Failing which I shall pay the full cost the equipment / article to the organizers.

[]  I have gone through the Terms and Conditions / cancellation policy / general notes to participate in the program in my full consciousness before signing and sending this application and aware of each and every details.

I am sending the participation fee of Rs. by M.Order no.
/ Cash [] / Bank Draft no. Dated in favour of "STIKAGE" payable at Delhi.




Your Signature with Date


Parents / Guardian's Consent:
[To be filled in by those under 18 years of age]

It is certified that my son / daughter / ward / Mr. Ms. ........................... is joining ............................... program with my consent. In case of any accident, illness or injury, I will not hold the organizers or its staff responsible in any way. It is also certified that he/ she is physically fit to undergo the rigours of the program.


Signature of Parent / Guardian with relationship with the applicant
Name ...................... Date .................


You may send this filled form to us, to check the availability of seat
and as information before hand.