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To Register for the Youth to Everest trek please complete the form below and submit; * indicates a mandatory field.
 
 
 
I would like to Register for Youth to Everest  *
First Name  *
Preferred Name  *
Last Name  *
Postal Address (No & Street or PO Box)  *
Suburb 
Town/City  *
Postcode  *
Street Address (for courier delivery)  *
Suburb 
Town/City  *
Country  *
School  *
Are you Boarding at School?  * yes   no  
Home Phone  *
Mobile 
Email  *
Date of Birth  *
Vegetarian  * yes   no  
Sex  *
Male
Female

Key Contact  *
Mother
Father
Other

Key Contact First Name  *
Key Contact Last Name  *
Key Contact Mobile No.  *
Key Contact Email  *
How did you find out about us? 
Are you wanting to use this trek for your Duke of Ed program?  * yes   no  
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