Project Application

Please complete the form below:

Simply fill in the form below to request our latest brochure

1. Personal Details

First Name:

Last Name:

date of birth:

2. Contact Details

Address:

Town/City:

County:

Country:
Postcode:

Daytime No:

Evening No:

Mobile No:

Email:

3. Medical Details

Are you taking any medication?

Please use this section to tell us about any significant current or past medical conditions that we should be aware of:

Do you have any special dietry requirements or food allergies
If yes to the above please give details:

4. Other Details

How did you hear about Madventurer?
If other please specify:

Occupation:

5. Volunteer Project Details

Destination
Start Date:
Duration:
Project Activity:





If other project activity please specify:
Adventure details:
Departure Date:

6. Payment

Reserve your place with a deposit payment of £150 by forwarding on a cheque to:

Madventurer HQ
Newcastle University Students' Union
King's Walk
Newcastle upon Tyne
NE1 8QB

Please write your name and address on the back of the cheque.

Or alternatively call us on 0191 232 0625 with your debit/credit card details or to set up a bank transfer.

Credit cards do incur a fee. There are are no charges for debit cards.

7. Declaration

I confirm that the information that I have provided is correct. I have read and understood all the information on the madventurers.com website and the terms and conditions information sheet with regard to the application procedure, acceptance of risk, foreign office advice, and security and inconveniences that may arise in the developing world outside of the control of madventurer.

Madventurer will not pass your details on to any one else, but we may wish to contact you in the future with news of special offers, updates and newsletters. If you do not wish to receive any future correspondance please tick the box below.


 

 

terms & conditions