Online Reservations

Please note that many of our programs take place in remote settings, where rescue may be difficult and definitive medical care can be far away. We use the information on this form to help us be sure that you have signed up for an appropriate trip with respect to your experience and ability level; and to aid us should a problem arise. In addition to filling out this form completely, we ask that you speak with one of our staff to help match your goals, physical conditioning, and experience to a trip which is appropriate for you. For some trips, you may be asked to consult a physician. Thank you for taking the time to provide us with complete information.


PERSONAL INFORMATION:
Trip Name: *
Trip Date: *
First Name: *
Last Name: *
Address:
City:
State:
Zip:
Home Phone:
Cell phone:
Birthdate:
Approx. Height & Weight:
Gender:
Email:
Emergency Contact Name:
Emergency Contact Phone:

 

Please list any medical issues and/or restrictions we should know about :

 

Please briefly describe any prior related experience.

 

Is there anything else you'd like to tell us?


How did you hear about SYMG?
Please enter no. of additional travelers



TRIP PAYMENT INFORMATION:

Please bill my credit card.
Full Trip Amount Deposit, bill balance at 60 days
Card Number:
Expiration Date:
Credit Card CVV Number:
(3 or 4 numbers on back of your card)
Name as it appears on Credit Card/Signature.
Enter address as in your credit card
Same as above
Address:
City:
State:
Zip:

I have read and understand the reservation and cancellation policies described in SYMG's Programs and Policies document.

All information on this form is personal and confidential. Other than correspondence between you and SYMG, your information will not be shared with other parties.

I have read and understand the Participant Agreement, Release, Acknowledgement of Risk and agree to be bound by its terms. Please note here that if you listed more than one person on the same form that a check mark indicates that you are agreeing to the terms for everyone on this form: husbands, wives, children etc.


This form may be submitted electronically, or you may print it out and mail it to the SYMG main office. Please note that you will be notified by e-mail once we've received your electronic form. Thank you.