Motive Travel Mezzanine Level BGC Centre, 28 The Esplanade Perth 6000 T: (08) 9322 2666E: motive@motivetravel.com.au www.motivetravel.com ACN 009411036 ABN 78009411036 Licence No 9TA 00504

IN THE STEPS OF THE EARLY EXPLORERSOkhaldhunga to Everest Base Camp

Have you ever dreamt of standing in the shadow of the world’s highest mountains? Or tip-toeing along mountain ridges straddling the roof of the world? What about staring deep into the eyes of a Himalayan monk? Or experiencing rural village life as it has been for hundreds of years?

On the Moonlight Community Healthcare Centre 2015 Fundraising Expedition, you will do all this and much, much more! Plus, a significant portion of each trekker’s expedition fee will be directly donated to the Moonlight Community Healthcare Centre.

Challenge yourself to take on this trip of a lifetime with conscience!

TRIP INCLUSIONS

• Return economy class airfares flying Singapore Airlines from Perth to Kathmanduincluding ticket taxes

• One way economy class airfare from Lukla to Kathmandu• Airport transfers• Accommodation and most meals as specified in the full information booklet• Professional, experienced, safety-conscious and government certified Moonlight Trekking

staff at every stage• Accompanying interpreters and cultural guides

BOOKINGS AND ENQUIRIESLaura Mannino or Viviana Russo-Castellano at Motive TravelE: laura@motivetravel.com.au E: viviana@motivetravel.com.auT: 08 9322 2666 F: 08 9322 1417

FURTHER TREK INFORMATIONNathan at Backpacker Medics E: nathan@backpackermedics.comFull information booklet: https://backpackermedics.files.wordpress.com/2014/11/2015_mchc_fundraiseexped2.pdf

* IMPORTANT - Please note that the MCHC Nepal Fundraising Trek will require a minimum of 10 participants to a maximum of 18 participants. Trek difficulty is medium to hard therefore a reasonable level of fitness is required of each participant. Booking terms, cancellation charges and other conditions apply. Tour cost subject to change due to currency fluctuations.

MCHC NEPAL FUNDRAISING TREKMarch 2nd - March 24th 2015

TOUR COST FROM

AU$4,700*per person twin share

Passenger Details (names exactly as they appear in your passport please)

Passenger 1

Title First name/s Surname

Home address

Home phone Work phone Mobile

Email Frequent Flyer Numbers

Passport number Nationality Date of birth

Passport expiry date Passport place of issue

Passenger 2

Title First name/s Surname

Home address

Home phone Work phone Mobile

Email Frequent Flyer Numbers

Passport number Nationality Date of birth

Passport expiry date Passport place of issue

Additional Information

Special meal requirements

Do you wish to extend your stay in Nepal? (additional payment applies)

Do you wish to stopover in Singapore on your return journey? (additional payment applies)

Travel Insurance

Travel insurance is highly recommended when travelling overseas. Additional premiums need to be paid for passengers with a pre-existing illness or who are aged over 70 years. An appraisal form needs to be completed if you are one of these passengers.

Do you require travel insurance? (please tick) oYes oNo

A travel insurance application form must be completed for a quote to be provided.

DepositA non-refundable deposit of $250 per person is payable within 7 days of your booking being confirmed. Final payment due 29 December 2014 subject to minimum numbers being met.

Payment Options

o Direct Deposit To Motive Travel, BSB 306 089, Account Number 3121178, email accounts@motivetravel.com.au to advise of transfer

o Cheque Post to Motive Travel, PO Box Z5327, St Georges Tce, Perth WA 6831

o Credit Card*

*2% merchant fee applies o Visa o Mastercard o American Express o Diners

Card Number________________________________________ Expiry Date_______________ CCV_______________

Name on card Cardholder signature

Acknowledgment of Confidential Information and Deposit Requiremento I acknowledge and give my consent to Motive Travel to use the above information solely for the purpose of organising travel arrangements

with Motive Travel and appropriate suppliers and will advise of any changes/updates to the information provided.o I acknowledge that a non-refundable deposit needs to be paid to Motive Travel to hold any travel arrangements.o I confirm that my level of fitness will meet the demands of a medium to hard level trek.o The signature provided below acknowledges the above for all passengers listed on this form.

Signature Date

Return completed form to Laura at Motive Travel via email laura@motivetravel.com.au or fax 08 9322 1417

Motive Travel Mezzanine Level BGC Centre, 28 The Esplanade Perth 6000 T: (08) 9322 2666E: motive@motivetravel.com.au www.motivetravel.com ACN 009411036 ABN 78009411036 Licence No 9TA 00504

MCHC NEPAL FUNDRAISING TREK 2015BOOKING FORM