(eg. 4x4 Overland from Shangri-la to Tibet, Climbing HaBa Snow Mountain, etc)

From:  (DD/MM/YYYY)   To:  (DD/MM/YYYY)

(as appear in travel document)

   Citizenship:  (country)
(please send us a softcopy of your passport with your photograph.  This is for  application of Tibet permit)

 (DD/MM/YYYY)

 (Mobile/Home)    (Email)
(please include country code)

   Relationship: 

 (Mobile/Home)    (Email)
(please include country code)

Mode of Payment: Cheque/Bank Transfer/Telegraphic Transfer to:

Bank Name : OVERSEA-CHINESE BANKING CORPORATION LIMITED (Singapore)
BIC/SWIFT Code : OCBCSGSGXXX
Address : OCBC CENTRE FLOOR 9, 65 CHULIA STREET, SINGAPORE 049513
Account Name : SHANGRILA ADVENTURE
Account No. : 569-010812-001

STATEMENT OF INDEMITY

I understand that participation in the above adventure activity organized by SHANGRILA ADVENTURE is completely voluntary and entirely at my own risk. I hereby undertake that I will make no claims against SHANGRILA ADVENTURE and keep fully indemnified from and against all claims for damages, costs, injuries, death and other demands, howsoever arising, which may be made or claimed against SHANGRILA ADVENTURE or which SHANGRILA ADVENTURE may incur by reason of or in connection with my participation. I understand that SHANGRILA ADVENTURE reserves the right to turn down or terminate my participation in or to abort or terminate the above activity at any time without assigning any reason whatsoever and I hereby undertake that I will make no claims against SHANGRILA ADVENTUTRE in respect of any costs or losses that I may incur as a result of that decision.

 I Agree              (Date: DD/MM/YYYY)
(please mark " x " )