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Booking Form



Traveller Details

*Date of Birth

*Nationality

*Gender: Male Female Other

*Meal preference: Vegetarian Non-Vegetarian Gluten Free Vegan Other

Address

*Country

Contact Details

Emergency Contact Details

*Country

Passport Details

*Date of Issue

*Date of Expiry

Medical Details

*Blood group

*Do you suffer from Motion Sickness? Yes No

*Do you suffer from Sleep Walking? Yes No

*Do you suffer from Asthma? Yes No

If yes, please upload a detailed history, with the medicines and clearance from the doctor that you are fit to participate in the program.

*Do you suffer from Epilepsy? Yes No

If yes, please upload a detailed history, with the medicines and clearance from the doctor that you are fit to participate in the program.

*Do you suffer from Heart Disease? Yes No

If yes, please upload a detailed history, with the medicines and clearance from the doctor that you are fit to participate in the program.

*Have you had any bone/muscle injury or fracture in the past 6 months? Yes No

If yes, please specify.

*Are you allergic to any thing? Yes No

If yes, please specify.

*Are you taking any other form of medication? Yes No

If yes, please specify.

Upload Files

Upload documents for all detailed medical history, if required.


File(s) size limit is 20MB.

Please attach the relevant medical certificate and a clearance from the doctor deeming you fit for the program. You can click on the upload tab at the end of the ‘page to attach the documents.

PLEASE NOTE: Edspera reserves the right to refuse participation if not satisfied with the medical case history.

I hereby confirm that all information provided here is accurate and complete to the best of my knowledge. I have fully read and understood all the terms and conditions.