KENYA WILDLIFE MARATHON 2015 – REGISTRATION FORM Complete this form and send back with $500 Personal Information Name ____________________________________________________________________ First Middle Initial Last Are you a Runner? If Yes Select Marathon _____ Half-Marathon_____ 10K____ Address: ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Phone (with area code): Day: ____________________________________Evening:____________________________________ E-mail: ____________________________________________________________________________ Date of Birth _______________ Nationality ____________________ T-shirt size_______ (S, M, L, XL) Male __ Female___ Passport No_______________________ Country ___________________ Expiration date _________ Note: See Passport information on last page! Emergency contact person with contact information: ____________________________________________________________________________________ Emergency contact phone (including area code): ____________________________________________ Sharing with ___________________________________________ Need Room Mate ___________ Need a Single Room: ___________ Absolutely Amazing Travel – 9841 Villa Pacific Drive | Huntington Beach, CA 92646 | Tel.: 714-963-5281 & 800-707-0005 deposit to secure your spot! 1 KENYA WILDLIFE MARATHON 2015 – REGISTRATION FORM Special Requests or Conditions? (Food allergy, medical condition, physical limitation, ___________________________________________________________________________________ If runner, include number of previous Marathons ______ Best Marathon Time ________ Longest distance race you have completed: _______________________________________________ Date of the race: ____________ Your time for the race: _______________ Your personal best marathon time? _______________ Name and date of that race: ______________________________________________, ____________ Have you done a trail running race? ____yes ____no If yes, longest distance you ran? ___________ Name, date and finish time: ____________________________________________________________ Absolutely Amazing Travel – 9841 Villa Pacific Drive | Huntington Beach, CA 92646 | Tel.: 714-963-5281 & 800-707-0005 vegetarian, etc.): 2 KENYA WILDLIFE MARATHON 2015 – REGISTRATION FORM Customize your Package Basic Marathon Package ____ Extended Marathon Package ____ NEED Airfare? ________________ US Departure City ________________________________________________ Date________________ US Return City _________________________________________________ Date__________________ Include Race Entry for Marathon ____ Half-Marathon _____ How did you hear about this event? _______________________________________________________ Middle-Distance Race _____ Absolutely Amazing Travel – 9841 Villa Pacific Drive | Huntington Beach, CA 92646 | Tel.: 714-963-5281 & 800-707-0005 Kenya Wildlife Marathon 3 KENYA WILDLIFE MARATHON 2015 – REGISTRATION FORM Payment Details forms plus the $500 USD deposit confirms your space on the trip and in the race. An invoice for balance due will be sent to you electronically approximately 3 months before the start of the trip. A 3% processing fee will be applied to credit card payments. Please indicate your preferred payment method for your $500 USD deposit: Credit Card (PayPal) _______ Check _______ It is your responsibility to obtain all required travel documentation (Passport and Visas). If you need assistance, please do not hesitate to contact us. We will be more than happy to assist you. * * * Please sign and print your name and date this form to verify that the above information as provided by you is true and complete. ________________________________________________________ _______________________ Signature Date ________________________________________________________ _______________________ Printed Name Date of Trip Mail completed Registration form with $500 deposit (payable to Absolutely Amazing Travel) to: Absolutely Amazing Travel 9841 Villa Pacific Drive Huntington Beach, CA 92646 (714) 963-5281|(800)707-0005 (844) 233-5687 (Fax) [email protected] Travel Protection Insurance is Strongly Recommended. Absolutely Amazing Travel – 9841 Villa Pacific Drive | Huntington Beach, CA 92646 | Tel.: 714-963-5281 & 800-707-0005 A deposit of $500 USD is required to proceed with your booking. Only the completed and signed 4