APPLICATION PROCEDUREDear Guest,

The information requested in this Application Pack is needed to complete your registration for your 2012 Elbrus Expedition.

Please print, ready carefully, and complete this full document, signing where necessary, and scan and email it to Willie - E-mail: willie@patagonianexpd.com along with supporting materials such as your flight itinerary, in order to complete your registration! Enclosed:Form 1: Participant InformationForm 2: Travel and Insurance Information (a copy of your flight itinerary also needs to be emailed to BBE)Form 3: Participant Medical InformationForm 4: BBE General Terms and Conditions & BBE Policy Form 5: Acknowledgement of Risk and Contract

Finally, please make sure that your passport is valid for at least 6 months after the trip and has empty pages to avoid visa problems. Bring a photocopy of the photo page of your passport to Argentina, to be carried separately from your passport in case your passport is lost or stolen. This will help facilitate acquiring a replacement through the local consulate if that becomes necessary. You may also want to have several spare passport photos handy in case of unexpected visa or permit requirements.

Many thanks,

Willie

Page 1 of 10

9084 Treasure Way, Sandy, Utah 84093 Phone 801-440-2605 Fax 801-783-1824 www.benegasbrothers.com

FORM 1: PARTICIPANT INFORMATION ! ! PAGE 1 OF 1

Name of Expedition

Departure date for Session

Your Full Legal Name

Preferred Name

Address

Home Phone

Work Phone

Cell Phone

Email Address

Occupation Marital Status

Sex Height

Date of Birth T-shirt Size (S,M,L,XL)

In Case of Emergency please notify:

NameName

RelationshipRelationship

AddressAddress

Primary Phone Second Phone

Please include a high quality copy of the photo page of your passport (if not yet submitted) along with the following information:

Name shown in passport

Passport number

Date of birth

Date of issue

Place of issue

Citizenship

Place of birth

Accommodations (twin double rooms):Is there another member of this trip that you wish to be paired with?

AGREEMENT The information I have provided on BBE Form 1: Participant Information is true and correct.

Participant's Signature:

Date:

Page 2 of 10

FORM 2: TRAVEL & INSURANCE INFORMATION PAGE 1 OF 1

***Please email a copy of your flight itinerary to Benegas Brothers Expeditions***

TRAVELArrival Date & Time (Bariloche)

Name of airline you will be arriving on

Flight Number

Departure Date & Time

Name of airline you will be departing on

Flight Number

! ! ! ! ! ! ! !INSURANCEHealth, Rescue and Travel Insurance are required to join an Benegas Brothers INC. trip

HEALTHHEALTH

Provider

Address

Policy Number

Emergency claim telephone number

RESCUERESCUE

Provider

Address

Policy Number

Emergency claim telephone number

Date acquired

TRAVEL INSURANCETRAVEL INSURANCE

Provider

Address

Policy Number

Emergency claim telephone number

Date acquired! ! ! ! ! ! !How did you hear about Benegas Brothes Expeditions?!! ! ! ! !

Have you participated in other Benegas Brothers Expeditions trips/courses? If so, please list: !

Page 3 of 10

FORM 3: MEDICAL INFORMATION PAGE 1 OF 2 Please answer each question, providing detailed information on dates and type of medical treatment. Please attach a separate sheet(s) if necessary. Your signature on this form certifies that your statements below are true. Benegas Brothers Expeditions reserves the right to refuse service at the participant's expense due to misrepresentation of medical and biographical information.

1. Have you ever had frostbite or any related cold weather injury/illness (incl. eye problems)? !! ! ! ! ! ! ! ! ! ! � No �Yes Please describe:

2. List any major accidents, illnesses or operations you have had in the past five years:

3. List any/all physical/mental limitations or medical conditions that may restrict your ability to ski on this expedition:

4. Do you have shoulder, back or knee problems? �No �Yes Please describe:

5. Do you have any limitations on your activities? �No �Yes! Please describe:

6. List any/all medications you will be taking on this trip and why:

7. List any/all allergies to food and/or medication: Please specify:

8. Dietary restrictions - or are there any foods you cannot eat? (please specify below) � No dietary restrictions � Vegetarian � Other (to detail below)

9. Do you wear corrective lenses? ! ! ! ! ! ! �No �Yes 10. Do you smoke?! ! ! ! ! ! ! ! �No �Yes If you answer YES to any of the following, please describe in detail on a separate sheet (date, duration, severity, symptoms, limitations, etc)11. Have you ever had high blood pressure? �No �Yes12. Have you ever had a dislocation? �No �Yes13. Have you ever had diabetes? �No �Yes 14. Have you ever had asthma? �No �Yes15. Have you ever had epilepsy? �No �Yes16. Have you ever had heart disease? �No �Yes17. Have you ever had cerebral or pulmonary edema? �No �Yes18. Have you ever had a speech, visionary or hearing impediment? �No �Yes19. Are you familiar with standard first-aid and current CPR techniques? �No �Yes20. Do you have ANY other condition that may effect your health? �No �YesPlease specify:

CONTINUED..

Page 4 of 10

FORM 3 CONTINUED:FITNESS BIO PAGE 2 OF 2

Please describe what you do to keep fit and all ski / climb / ski mountaineering and other outdoor experience you may have. This information is very useful, as we strive to cater each trip to match individual needs and goals. Signing this form indicates that you understand and comply with the physical fitness requirements for your program.

Your height:Your weight: Sex:

Weekly fitness routine:

How will you modify your training regimen to prepare for this trip? (If applicable)

Please list all ski / climb / ski mountaineering and other outdoor experience you may have. Attach additional sheet if necessary.

I, _____________________________________, hereby consent to any hospital care or medical or surgical diagnosis or first aid activities with Benegas Brothers Expeditions Inc and its agents, if I am not able at that time to give my written consent due to unconsciousness, disorientation or other mental incapacity. I also understand and agree that I am solely responsible for all appropriate charges for such services and that Benegas Brothers Expeditions Inc and its agents are under no duty to provide any first aid or medical treatment in any event.

Signature of participant: ! ! ! ! ! !

Name of Participant:!Date:! ! ! ! ! !

Signature of physician: ! ! ! ! ! !

Name of physician:Date:! ! !

Page 5 of 10

BBE GENERAL TERMS AND CONDITIONS PAGE 1 OF 3

PAYMENT SCHEDULE After acceptance to join a BBE Everest Expedition, a non-refundable deposit is required within one month of acceptance to secure a position. Deposits Non-refundable deposit plus any wire transfer fees of $___________.Final payment The remaining balance of the trip fee is due on the ________________.How to pay Payments may be made by Wire Transfer; late payments may result in cancellation of your reservationSend US personal checks to:! ! Wire Transfer should be sent to: ! !Benegas Brothers Expeditions! ! Benegas Brothers Expeditions9084 Treasure Way ! ! ! Chase BankSandy, UT 84093! ! ! ! 9502 South Highland Drive, Sandy, UT 84092

ACC# 881-729651Swift Code: CHASUS33Aba/Routing# 124001545

*Payment notes: 1. If wiring payment, please be certain that you are covering ALL fees (i.e. wire transfer fees)! Deposits are non-refundable and non-transferable. This is not a flexible policy. Planning our trips takes significant time and has non-refundable costs as well. Payment should be made as described above, and must be made in US Dollars $. 2. The cost of your trip includes land costs: double occupancy lodging while in towns, meals on the mountain from Base Camp and above, scheduled transportation, group camping and climbing equipment, and guides. The cost of your trip does not include: flights to/from the city where the expedition begins, airport taxes, visas, immunizations, tips for guides or local staff, travel, rescue, or any other type of insurance, hospitalization or evacuation costs and any costs associated with abandonment of the group itinerary, single supplement charges, excess baggage charges, alcohol, or other personal expenses. 4. The costs of delays or changes to itinerary that are beyond the control of Benegas Brother Expeditions or its agents are not included.

CANCELLATIONS AND REFUNDSIn a event that you need to cancel your trip BBE must be notified in writing. Your trip will be cancelled from the date we receive and acknowledge your written notice. Your cancellation will be assessed and a cancellation fee applied according to the following schedule: More than 90 days: $1000 charge (your full deposit) plus any bank charges to return the remaining balance; 89 to 60 days: 50% of the trip cost charged plus any bank charges to return remaining balance; less than 60 days: 100% of the trip cost.

CANCELLATIONS BY BBEBBE reserves the right to cancel any trip at any time. Reasons for cancellation might include (but are not limited to) political instability, natural disasters, or inadequate enrolment. If we cancel a trip prior to its start, we fully refund your payments less any bank charges payable to make the refund, or your monies will be transferred to another BBE expedition, plus or minus its advertised price less bank charges for any returned part or transferred to another operator’s expedition. Changes to a trip itinerary made by our guides for any reason do not constitute a cancellation, and no refunds will be made in this case. Travel insurance is highly recommended and is required to complete your booking.

TIER PRICINGWhen trips do not fill to the required level, a price adjustment may become necessary to avoid trip cancellation. If after discussion, participants are unable to agree on pricing adjustments, a partial refund may be given, excluding the deposit and any bank charges payable to make the refund.

SAFETY AND PARTICIPANT RESPONSIBILITYParticipants have responsibilities to themselves, Benegas Brothers Expeditions, and to each other. They must choose the trip that is appropriate for their interests and skill level. Good physical condition is important on all Benegas Brothers Expeditions and is a prerequisite for participation. Proper trip preparation includes, but is not limited to, acquisition of the proper equipment, understanding the trip's itinerary, awareness of local customs and traditions, and familiarity with proper wilderness etiquette. On a trek or expedition, our guides reserve the right to remove any person from a trip, for any reason. These reasons generally stem from a person jeopardizing the safety of themselves or another team member. This includes a person who is not physically able to ski at the level necessary for the chosen route. In all these cases, there are no refunds whatsoever, and the client will be responsible for any additional costs incurred in leaving the trip.

Page 6 of 10

PAGE 2 OF 3FLIGHTS **Please confirm your itinerary with Benegas Brothers Expeditions** BBE is not responsible for the terms and conditions of any airline tickets.

INSURANCEWe require the purchase of insurance plans to protect you from the unexpected. Please consult with your insurance company with any specific questions, regarding coverage, and policy details, and if you have any questions contact our offices. Ingles Insurance: Emergency evacuation insurance covering treatment abroad www.inglegroups.com/bbe  (does not cover baggage / gear loss)General Travel and Trip Coverage: Travel Guard (US Toll Free 800-826-4919) provides coverage to protect against trip cancellation, interruption, or delay due to unforeseeable sickness, injury or death of you or a family member. Coverage also includes trip cost default protection; stolen or damaged luggage; and trip or baggage delay protection. Coverage should include lost or damaged baggage, BBE is not responsible for the personal items or baggage of its members at any time.

MEDICAL AND HEALTHIn the event of a serious medical problem, please be aware that hospital facilities are usually far away and a doctor may not always be available. If an evacuation becomes necessary, be aware that it can be difficult, expensive, and very time-consuming. If you require immunizations or booster shots, get them early. Included in this packet is a Medical History and Release Form. These forms need to be signed by a physician and returned to Benegas Brothers Expeditions. Trip leaders need to be aware of any medical contingencies that apply to members of their group. Benegas Brothers Expeditions reserves the right to disqualify for medical reasons any client from any portion of a trip. No refunds are given under these circumstances. If a physician fails to approve the medical release form after payment has already been made, the standard cancellation policy applies (see Cancellations and Refunds above).

BENEGAS BROTHERS EXPEDITIONS EXPENSESBenegas Brothers Expeditions covers all land costs as part of the overall trip fee. Land costs include accommodations, guide services (both Benegas Brothers Expeditions and local guides), all meals whilst skiing (unless otherwise noted in your contract), porters and/or pack animals, cooks, ground transportation (unless otherwise noted in your contract), and all group gear for the duration of the scheduled trip. The cost of delays, included but not limited to road or trail conditions, airline delays, government intervention, illness, or any other contingency that we or our agents cannot control, are not covered by BBE. Benegas Brothers Expeditions reserves the right to modify the trip fee at any time.

PARTICIPANTS’ EXPENSESThe participant is responsible for his or her international airfares, personal/travel insurance (see above) and visa fees, excess baggage fees and airport taxes. He/she is also responsible for his/her meals, prior to or after the actual scheduled trip or meals that he/she chooses as alternatives to the ones offered by BBE, any additional room charges (e.g. room service), laundry services, phone calls and other personal expenses, tips for guides and staff, medical costs and/or subsequent prescriptions, and any costs of hospitalisation and/or evacuation required for him/her including any costs associated with the abandonment of the group itinerary and/or subsequent associated costs including (but not limited to) accommodation, meals and transport costs incurred either on their behalf or as a result of their actions. Please confer with hotels or with Benegas Brothers Expeditions guides about in-country telephone surcharges. In addition to souvenirs and gifts, plan on spending on airport departure taxes, alcohol and snacks, and tips for local staff and your guides.

Page 7 of 10

PAGE 3 OF 3

BENEGAS BROTHERS EXPEDITIONS INC. (BBE) POLICYBENEGAS BROTHERS EXPEDITIONS reserves the right to refuse a person participation on any trip if we find that person to be mentally unprepared for the trip. During the trip the Lead Guide reserves the right to require a person to return to base camp or to abandon the trip, if by their judgment, for any reason, a person is unfit to continue participating in an ongoing activity. If, for any reason, anyone leaves the trip before its completion, for whatever reason, there will be no reimbursement of fees. If the weather, or other factor(s), makes completing our objective impossible, there will be no reimbursement of fees. If the participants require a rescue or the participant leaves the trip before its completion, for whatever reason, the participant is responsible for any expenses incurred. BBE is not responsible for any expenses incurred if the trip should be delayed due to weather, strikes, theft, acts of nature, civil disturbances, terrorism, acts of war, government restrictions or regulations, failure of any form of transportation to arrive or depart as scheduled, or discrepancies over which BBE has no control. If the participant cancels at any time before the activity, there will be no refund of deposit.

BBE reserves the right to increase the price of the expedition to reflect any increase in the cost to BBE which is due to any factor beyond the control of Benegas Brothers Expeditions (such as without limitation any foreign exchange fluctuation currency regulation alteration of permissions or licenses or other associated costs that may affect the Expedition). BBE will give notice in writing at least thirty (30) days prior to the departure date. No refunds will be issued on whole or partially unused portions of packages or unused services.

BBE is not responsible for the terms and conditions of any airline tickets. BBE is not responsible for lost, stolen, or damaged baggage or equipment, or any expenses incurred in the event of such loss or damage. If BBE chooses to cancel a trip for reasons other than the above stated, payment will be refunded in full.

NAME OF PARTICIPANT _____________________________________________

I have read, understand, and accept the terms and conditions stated above along with the BENEGAS BROTHERS EXPEDITIONS POLICY and acknowledge that this agreement shall be effective and binding upon the parties during the entire period of participation in the said activity(s).

PARTICIPANTS SIGNATURE: _______________________________________

DATE:!! !

TRIP: !!

Page 8 of 10

PAGE 1 OF 2

BBE ACKNOWLEDGEMENT AND ASSUMPTION OF RISK, RELEASE AND INDEMNIFICATION PLEASE READ AND UNDERSTAND THESE POLICIES BEFORE SUBMITTING YOUR APPLICATION TO BENEGAS BROTHERS EXPEDITIONS

In Consideration of the services provided by Benegas Brothers Expeditions INC. its shareholders, directors, officers, employees, agents, volunteers, participants and all other persons or entities associated with or acting in any capacity on its behalf (collectively referred to as “BBE”), I hereby agree to release, indemnify and discharge BBE, on behalf of myself, my heirs, assigns, personal representative and estate and for all members of my family, including minor children, as follows: I acknowledge that skiing, and ski mountaineering in all its forms entail known and unanticipated risks that could result in physical or emotional trauma, injury, paralysis, death or damage to myself, property and/or third parties. Although BBE has taken reasonable steps to provide me with appropriate equipment and skilled guides, I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. These risks include, among other things: the hazards of traveling in uneven mountainous terrain and slips and falls; being struck by rock fall, ice fall or other objects dislodged or thrown from above; the use of climbing ropes and equipment; the forces of nature, including lightning, weather changes and avalanche; the risk of falling off the rock, mountain or into a crevasse; the risk of exposure to insect bites; the risk of cold including hypothermia; my own physical condition; and the physical exertion associated with this activity. Additional dangers may include the hazards of traveling in the Third World; accidents or illness in remote places without access to emergency medical facilities; war, terrorism and other forces. I understand that this description of these risks is not complete and that other unanticipated inherent risks may exist. Furthermore, I acknowledge that BBE has a difficult job to perform. It seeks safety but is not infallible. It might be unaware of my or another participant’s fitness or abilities. It might misjudge the weather or other environmental conditions. It may give incomplete warnings or instructions and equipment being used might malfunction. I acknowledge that engaging in this activity may require a degree of skill and knowledge different than other activities and that I have responsibility as a participant. I acknowledge that BBE has been available to me to more fully explain the nature and physical demands of this activity and the risks, hazards, and dangers associated with this activity.

Initials _______________I AM VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES WITH KNOWLEDGE OF THE DANGER INVOLVED, HEREBY. I AGREE TO ACCEPT ANY AND ALL RISKS OF INJURY OR DEATH, AND VERIFY THIS STATEMENT BY PLACING MY INITIALS ABOVE.!

Initials _______________ 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 BBE 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.

Initials _______________ I certify that I am fully capable of participating in this activity. Therefore, I assume and accept full responsibility for myself, including all minor children in my care, custody and control, for bodily injury, death, and loss of personal property and expenses as a result of those inherent risks and dangers identified herein and those risks and dangers not specifically identified, and as a result of my negligence in participating in this activity.

Initials _______________ I have had sufficient opportunity to read this entire document. I have carefully read, clearly understood, and accepted the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon myself, my heirs, assigns, personal representative, estate and for all members of my family, including minor children.

Page 9 of 10

PAGE 2 OF 2

RELEASEAs consideration for being permitted by BBE or one of its affiliated organizations to participate in these activities and use their facilities, I hereby agree that I, my assignees, heirs, distributes, guardians, and legal representatives will not make a claim against, sue, or attach the property of BBE or any of its affiliated organizations [or the supplier of any of the equipment I will use in these activities] for injury or damage resulting from the negligence or other acts, howsoever caused, by any employee, agent, or contractor of BBE or any of its affiliated organizations as a result of my participation in activities offered by BBE. I hereby release BBE and any of its affiliated organizations from all actions, claims, or demands that I, my assignees, heirs, distributes, guardians, and legal representatives now have or may hereafter have for injury or damage resulting from my participation in the activity.

ARBITRATION AGREEMENTAny claim or controversy arising out of or relating to the agreement or the performance there under, including without limitation any claim relating to illness, injury or death, shall be settled by binding arbitration in Sandy, Utah in accordance with the rules of the American Arbitration Association then existing and the laws of the State of Utah, and the judgment on the arbitration award, including reasonable attorney fees, may be entered in any court having jurisdiction over the subject matter of the controversy. This agreement to arbitrate does not waive or modify the liability release contained in the foregoing paragraph.

I have carefully read, clearly understood and accepted the terms and conditions stated herein, including the arbitration agreement, and acknowledge that this agreement shall be effective and binding myself, heirs, assigns, personal representatives and estate and for all family, including minor children. I am aware that this is a release of liability and a contract between myself and BBE and/or its affiliated organizations and sign it of my own free will.

Signature of Participant: ! ! ! ! ! !

Date: ! ! ! !

Print Name:!

Declaration of WitnessI certify that [name of participant] _________________________________ acknowledged in my presence, had read and fully understood the meaning and consequences of the foregoing release, and signed it in my presence.

Signature of Witness:

Date:

Print Name:

Page 10 of 10