AMG BOOKING FORM Today's Date* Which AMG Program are you applying for?Aconcagua Normal RouteAconcagua Polish Traverse 3607 Day Trek3 Day TrekClimber ServicesOutfitter ServicesPreferred Departure Date Of Program (MM/DD/YYYY)* Mailing AddressFirst Name*Last Name*Preferred NameEmail* Enter Email Confirm Email Address* Street Address * Address Line 2 City * State / Province * ZIP / Postal Code * AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country * Home Phone*(or primary contact number)Work PhoneCell PhoneCredit Card Information Please note at time of sign up, if the balance is already due, the entire cost of the trip must be paid. (Trip balances are due at 46 days) Just enter the correct full amount in place of the deposit below. Payment Amount (USD)*Credit Card Number (no spaces or dashes)Expiration Date (MM/YY)CR2/CV CodeWhat's This?I would like to use the Auto-Pay feature and have my balance automatically charged on the due date.YesNoPayment AddressBilling Address My Billing Information is the same as my Mailing Information above. Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Notes for our Program Staff regarding your reservation go here:Room Share I prefer to share a double room I prefer Single accommodations at an additional cost Is there another member of this program that you wish to be paired with? Personal InformationOccupationDate of Birth (MM/DD/YYYY)* Sex*MaleFemaleHeight*Weight*T-shirt SizePassport # (Can be submitted later)*Date of Issue (MM/DD/YY)Date of Expiration (MM/DD/YY)Place of IssuePlace of BirthCitizenshipIn Case Of Emergency Please NotifyName*Relationship*AddressPhone*Member NameMEDICAL INFORMATIONPlease answer each question in earnest using the fields below. You may also send a separate email to firstname.lastname@example.org. Your signature/check mark on this form certifies that your statements are true. Aconcagua Mountain Guides reserves the right to refuse service at your expense due to misrepresentation of biographical information. Please note that medical information will be shared with your guides to assist with any health-related issues while on your course or expedition. Signing this form indicates you comply and understand the physical requirements for this program.Please list any accidents, operations or illnesses you have had in the past:Have you been hospitalized in the past two years? If yes, please describe.YesNoPlease Describe:Have you ever had frostbite or any related cold weather injury/illness?YesNoPlease Describe:Have you ever experienced any form of altitude illness? If so, please describe rate-of-ascent, altitude, medication and recovery procedures.YesNoPlease Describe:Please list ALL medications being taken during the trip and reason for medication:List any and all food or medication allergies:Please list all dietary restrictions:Do you wear corrective lenses?NoYesDo you currently smoke or have you been a past smoker?NoYesPlease ExplainDo you have any pre-existing conditions not mentioned above. If so, please describe.NoYesPlease DescribeAre you familiar with standard first-aid and current CPR techniques?YesNoPlease list your current medical insurance provider:Please check and describe below if any history of: Back Problems Knee Problems Neck Problems Circulation Problems Ankle Problems Arm & Shoulder Problems Head trauma or injury or chronic headaches/migraines Internal problems such as diabetes, hypoglycemia, intestinal or kidney problems Respiratory issues such as asthma High or low blood pressure, heart condition, blood disease or irregular heartbeat Hearing or vision impairment Joint dislocations, sprains, hernia Cancer Seizure Disorder Describe Medical History From AboveBy checking this box and typing my name, I am signifying that the above medical information is correct.* Yes TERMS AND CONDITIONSThe following general conditions are governed by the provisions set forth in Act 18.829, Decree 2.182/72, and Resolution 404/72. This document, (Terms and Conditions) is a binding contract between Aconcagua Mountain Guides SA, with offices at 352 Beltrán St., Godoy Cruz, Mendoza, their officers, agents, employees, and owners, and all other persons or entities associated with those businesses (hereinafter collectively referred to as “AMG”) and you, the participant in an AMG program, (herein referred to as “participant”). In consideration of the services of AMG I agree as follows: RESERVATIONS: No reservations will be made until a deposit is received. Payment can be made by credit card or wire transfer. Reservations will be received and confirmed once you: Submit the completed booking form. If you are participating as a group, each applicant must complete a booking form. It is the participants responsibility to let us know if the information specified here changes before the departure. The participant may sign up using our online application on AMG’s website or request a PDF application from our office. Payment can be made by credit card or wire transfer to our bank account. All wire fees will be paid by the participant. PRICES: all prices advertised in AMG publications are expressed in United States Dollars and are subject to changes without prior notice. The passenger accepts the listed price at the time the deposit is received by AMG. AMG will directly send a package with price confirmation and other pertinent information. RESERVATION CONFIRMATION: once your application and deposit are received, ACONCAGUA MOUNTAIN GUIDES SA will confirm your reservation via e-mail and include a confirmation package with important information about your trek, climb or other activity (herein referred to as “program”). This includes gear lists, physical training routines and other information pertaining to your program. KNOWLEDGE OF CONDITIONS SET FORTH: when the participant sends the completed application and deposit for a program and it is accepted by ACONCAGUA MOUNTAIN GUIDES SA, it is understood that the participant acknowledges and agrees to all the conditions herein and certifies that the information submitted in the application is complete and true. BALANCE DUE: All balances are due 46 days prior to departure date of your trip. CANCELLATION AND REFUND POLICY Note: AMG highly recommends trip cancellation insurance for all programs. If you cancel 46 days or more prior to departure date you can apply funds to a future AMG program. If you cancel 45 days or less prior to departure date, the balance and deposit are non-refundable. Participants whose balances are not received 46 days or more before the departure date of their program as stated in the application, risk forfeiture of their place in the program. Note: AMG reserves the right to waive any fees. As we offer personalized service, we will attempt to accommodate changes and cancellations when necessary, waiving certain fees when feasible. ARGENTINE VISA: it is the passenger's responsibility to obtain the necessary visa to enter Argentina. Please contact us if you need assistance with the process. If you fail to acquire a valid visa, the refund policy still applies to your scheduled program. LUGGAGE: the luggage and personal effects shall be, at all times, the passenger's responsibility. Not only in Mendoza city, but also on the mountain. If a participant decides to leave the expedition early or is evacuated due to health problems, etc., they will be responsible for their equipment, personal belongings, and rented gear. In the event of an accident, loss or damage during the transfer of luggage in/on AMG’s vehicles, porters or mules, AMG shall be liable to pay up to a maximum of USD 200. TRIP CANCELLATION INSURANCE: As there are many unforeseen circumstances that may occur before and during the program, we highly recommend trip cancellation insurance. Please see our website for trip cancellation or interruption insurance. Participants acknowledge that they are advised to buy personal life, medical, accident, travel baggage, cancellation, interruption, rescue, repatriation and other insurance that may pertain to their participation in the program. Participants understand that AMG provides the participant with no such insurance coverages. ADDITIONAL EXPENSES: AMG program members are responsible and will pay all expenses incurred or associated with departing their program early for whatever reason including but not limited to illness, injury or other personal reasons. The Participant is responsible for paying for their own evacuation, rescue, transport and for all other services not included in the AMG program. The Participant acknowledges they have the necessary insurances to cover this type of expenses or have sufficient financial capability to pay these costs. PARTICIPANT RESPONSIBILITY: Trip participants are responsible for their own well-being. This includes good health and strong physical condition. Participants joining a program may be required to obtain a physician's release prior to departure. Program members are responsible for: knowing all pre-departure information, preparing proper equipment and clothing, conforming to basic standards of personal hygiene (to minimize the risk of traveler's diseases) and acting in a considerate manner toward all group members and with respect for each country's customs. Participant also agrees to follow the appropriate, “Leave No Trace” environmental practices. Participant gives their consent for Aconcagua Mountain Guides to use their photograph, likeness and/or voice to be used in its publications, including its website. ADDITIONAL TERMS TO PARTICIPATE IN AN AMG PROGRAM We are committed to helping climbers and trekkers achieve their personal goals safely and enjoyably. Aconcagua Mountain Guides SA, its owners, sponsors, agents, employees, officers, directors, associates, affiliated companies and subcontractors (herein after collectively referred to as "AMG"), hereby give notice that they act only as agents for hotels, transportation companies, land operators and suppliers of travel services. AMG assumes no responsibility or liability in connection with the operation or service of any aircraft, motor vehicle, other conveyance, inn, lodge or hotel which may be used wholly, or in part, for services by AMG and its clients. AMG, its operators, airlines and agents will not be responsible for any act, error, omission, nor for any injury, loss accident, delay, inconvenience, irregularity or damage which may be occasioned by any cause whatsoever. This includes, but not limited to acts of nature, civil disturbance, government restrictions or failure of any means of conveyance to adhere to published schedule. AMG reserves the right to change the price of, cancel or withdraw any program for any reason whatsoever prior to departure. After departure, AMG reserves the right to alter or omit any part of the itinerary, to substitute hotels or leaders, to change any means of conveyance without notice and without allowance of refund, with liability for increased costs (if any) borne by the program members. AMG reserves the right to accept or reject any person as a program member at any time. GUIDES: RIGHTS AND OBLIGATIONS: Given the nature of the service hired by the participant, the decisions taken by the guide as program leader are final. If the guide considers that the participant’s behavior, physical condition, mental illness or any other reason emanating from said participant may be dangerous to the safety, health or well-being of said participant or of the whole group, the participant will be asked to leave the program and shall not be entitled to any refund whatsoever and be responsible for any additional costs associated with their departure such as but not limited to transportation, hotels, meals, etc. The guide, as the group leader, can decide on any changes to the itinerary, including ending the program if he/she considers the team is in danger and if such change will be for the good of the program. The participant acknowledges the guide's authority concerning decisions that encompass changes in the program. SUMMIT ATTEMPT AMG will make its best effort to provide you with a summit attempt with in the guidelines of this document and itinerary. AMG cannot guarantee that you will reach the summit of a peak. Weather, route conditions, your own abilities or the abilities of other climbers may create circumstances that make an ascent unsafe and you or your entire team may have to turn around without reaching the summit. No refunds will be given by AMG for not reaching the summit for any reason. AGREEMENT TO TERMS AND CONDITIONS DOCUMENT In consideration of the services furnished me, and to be furnished me as a participant of an AMG program, I hereby agree to all terms and conditions in this document, (TERMS AND CONDITIONS), and furthermore release AMG and all the participants of the program from any and all damages, injuries, losses, or any cause of action which may result in me, my legal representatives or others purporting to exercise statutory or other rights arising out of, or in connection with this program. And I hereby assume each and every damage incident to my participation and agree to indemnify and hold harmless AMG and all participants of the program against any sums which they, or any of them may be subject to pay in consequence of any claim or demand by or through me or resulting from my being a participant of this program. In the event that I file a lawsuit against AMG, I agree to do so solely in Mendoza, Argentina. Any conflict shall be settled by the Ordinary Courts of the First Judicial District of Mendoza, and excludes any other court and/or jurisdiction, including the Federal Court. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. I have had sufficient opportunity to carefully read this entire document and clearly understand and voluntarily agree to be bound by its terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon me, my heirs, assigns, personal representative and estate and for all members of my family, including, my spouse and minor children. By Checking this box, I certify that I agree to all TERMS & CONDITIONS as stated above.* Yes Full Name*Date PARTICIPANT AGREEMENT, RELEASE, AND ACKNOWLEDGEMENT OF RISKIn consideration of the services of Aconcagua Mountain Guides SA, their officers, agents, employees, and owners, and all other persons or entities associated with those businesses (hereinafter collectively referred to as “AMG”) I hereby agree as follows: Although AMG has taken reasonable steps to provide me with appropriate equipment and skilled guides so I can enjoy activities such, for which I may not be skilled, AMG has informed me there are significant elements of risk in any of these activities including training courses that teach the activities. Certain risks are inherent in each activity and cannot be eliminated without destroying the unique character of the activity. These inherent risks are some of the same elements that contribute to the unique character of these activities and can be the cause. AMG does not want to frighten me or reduce my enthusiasm for these activities, but believes it is important for me to know in advance what to expect and to be informed of the inherent risks. The following describes some, but not all, of the inherent risks while participating in these activities. Foreign countries have their own laws and standards of acceptable conduct; food and water related illnesses; foreign political, legal, social, transportation, health, and economic conditions; different standards of design, safety, and maintenance of buildings, public places, and conveyances; local & medical facilities and providers; weather conditions; criminal activity, environmental hazards; standards of living and health standards that are not equivalent to your home country Transportation; (before, during and after the activities) by plane, helicopter, automobile, van, bus, taxis, truck, train or other motorized transport can all have significant risks associated with them. Pack and riding animals used for carrying gear and for riding in some circumstances, for example; camels, yaks, mules, lamas, horses and other pack animals can bite, kick, gore with horns, become uncontrolled, push or knock gear or people off trails or other terrain. Injury or Illness caused by, but not limited to, contaminated or untreated water, wild, dangerous or poisonous animals and plants, bites from disease carrying insects, different standards of living conditions, different foods or difficulty maintaining hygiene, travel in remote areas with poor or no access to emergency and/or medical services. Slipping or falling: Travel by foot (including to, during and from the activities) over uneven rugged unpredictable trail and off-trail terrain, including but not limited to, boulder fields, downed timber, river crossings, high mountain passes, snow and ice, glaciers, crossing crevasses and snow bridges, steep slopes, and slippery rocks may result in slips and falls which may cause pinches, scrapes, twists and jolts that could result in scratches, bruises, sprains, lacerations, punctures, fractures, concussions, or even more severe life threatening injuries and death. Being struck by avalanches, rockfall, icefall, or other objects dislodged or dropped from above can cause severe injuries or death. Glacier travel hazards include falling into a crevasse or breaking through a snow bridge resulting in a crevasse fall which can cause injuries due to the fall or objects hitting you during and after your fall. You may also be injured while stopping in the bottom or between the sides of the crevasse. Once in a crevasse you will be subject to cold and hypothermia. Camping hazards including open flame stoves, burns, tent fires, carbon monoxide poisoning, food and water related illnesses. Inclement weather and rapid changes in weather, including mountain storms, server cold or heat, extreme winds, limited visibility, electrical storms or lightning, snow, hail, ice, rain and sleet can cause difficult and dangerous situations greatly increasing risk. Extreme heat and heat related illnesses, including heat exhaustion and heatstroke. Extreme cold or cold injuries such as hypothermia, frostnip or frostbite that may result in loss of limbs, digits and permanent scarring. Altitude related sicknesses and conditions including but not limited to AMS (acute mountain sickness), Pulmonary Edema, Cerebral Edema and retinal hemorrhaging. Dehydration related injuries or illnesses. Damage, failure, loss or misuse of equipment can lead to loss or damage to equipment, or accidental injury, illness, or in extreme cases, permanent trauma or death; some causes but not all include environmental, such as extreme cold or heat, rockfall, icefall, avalanches, high winds. For example, damaged tents from wind, sun or snow burial. Failure of climbing protection due to high temperatures melting out snow and ice anchors. Falling rock hitting and cutting climbing ropes. Human causes such as, dropping, loosing, inappropriate use, or not well maintained climbing equipment. Some examples, a cook stove leaking and causing a fire, or climbing on fixed lines that anchors or ropes have not been sufficiently maintained causing failure and a fall. A lost glove leading to cold injuries. AAI employees have difficult jobs to perform. They seek safety, but they are not infallible. For example, they might be unaware of a participant's fitness or abilities. They might misjudge the weather, other environmental conditions. They might misjudge whether the terrain is safe for travel or where or when an avalanche may occur. They may give incomplete warnings or instructions, and the equipment being used might malfunction or be used incorrectly. They may make an incorrect medical diagnosis or treat an illness or injury incorrectly. My own and other participant’s physical capabilities/limitations and the physical exertion associated with the activities, which may contribute to loss of balance; physical coordination and inability to follow instructions. For example, fatigue which may causes dizziness during the activities and diminish reactions time or judgement increasing the risk of an accident or injury. The actions or inactions of other participants in the group or third parties that may contribute to the risk. An “act of God”, or uncontrollable act of nature including, but not limited to, avalanche, icefall, rockfall, earthquakes, floods and extreme weather. I am aware that hiking, trekking, rock climbing, ice climbing, mountaineering, glacier travel, ski touring, ski mountaineering and other related activities, (herein known as “the activities”) entails risks of injury or death to any participant. I understand the description of these inherent risks is not complete and that other unknown or unanticipated inherent risks may result in injury or death. I agree to assume and accept full responsibility for the inherent risks identified herein and those inherent risks not specifically identified. My participation in this activity is purely voluntary, no one is forcing me to participate, and I elect to participate in spite of and with full knowledge of the inherent risks. I acknowledge that engaging in this activity may require a degree of skill and knowledge different than other activities and that I have responsibilities as a participant. I acknowledge that the staff of AMG has been available to more fully explain to me the nature and physical demands of this activity and the inherent risks, hazards, and dangers associated with this activity. I hereby authorize any medical treatment or rescue deemed to be necessary. I hereby give permission for transportation to any medical facility or hospital and I authorize for any qualified guide or medical personnel to render necessary emergency medical care for myself and all minor children in my care, custody and control while participation in these activities. I hereby authorize the release of any medical information in the possession of AMG to any medical facility, hospital, ambulance, first aid provider, first aid service, doctor, nurse or other such person rendering care on my behalf. I hereby waive any action or claim against AMG or any health care provider, hospital, doctor, nurse or first aid provider for the release of this medical information. I certify that I AM FULLY CAPABLE of participating in this activity and I acknowledge that I AM ULTIMATELY RESPONSIBLE for my own safety and the safety of all minor children in my care, custody, and control while participating in these activities. Therefore, I assume and accept full responsibility for myself, , for bodily injury, death or loss of personal property and expenses as a result of those inherent risks and dangers identified herein and those inherent risks and dangers not specifically identified, and as a result of my negligence, the negligence of AMG and other participants and third parties, while participating in this activity. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless AMG from any and all claims, demands, or causes of action, which are in any way connected with my participation in these activities or my use of AMG's equipment or facilities, including any such claims which allege negligent acts or omissions of AMG, other participants in the group and third parties. Should AMG or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I am willing to assume the risk of any medical or physical condition I may have. In the event that I file a lawsuit against AMG, I agree to do so solely in Mendoza, Argentina. Any conflict shall be settled by the Ordinary Courts of the First Judicial District of Mendoza, and excludes any other court and/or jurisdiction, including the Federal Court. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. I have had sufficient opportunity to carefully read this entire document and clearly understand and voluntarily agree to be bound by its terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon me, my heirs, assigns, personal representative and estate and for all members of my family, including, my spouse and minor children.By checking this box and typing my name, I agree to all terms and conditions in PARTICIPANT AGREEMENT, RELEASE, AND ACKNOWLEDGEMENT OF RISK.* Yes Full Name*Date CommentsThis field is for validation purposes and should be left unchanged.