Kilimanjaro Registration Form 2019.V7

Kilimanjaro Registration Form

Traveler's Information
As it appears on your passport
As it appears on your passport
As it appears on your passport
What name would you like to be called if different from your passport
Month Day, Year
Month Day, Year
Used for private charters/helicopters

Medical Information

Please answer each of the following health questions by providing detailed information that includes dates and medical response. Please let us know of any changes!