Booking form - Alpine-rock climbing and mountaineering in Canada with Selkirk Mountain Experience at the Durrand Glacier Chalet

Booking form

Please print out this form, complete and mail to Selkirk Mountain Experience

Name:

Street:

City - Province/State:

Postal/Zip Code - Country:

Home Phone (including area code):

Business Phone (including area code):

Email Address:

Emergency Contact Name:

Relationship to Emergency Contact:

Emergency Contact Phone:

Program Name:

Program Date/ Number of People:

Enclosed Deposit of:

Date:

Signature of Applicant:

Mail completed form to:
Selkirk Mountain Experience
Box 2998, Revelstoke, BC
Canada V0E 2S0