Wild Med Adventures

Name *

First Name

Last Name

Phone *

(###)

###

####

Single Room (Extra Fee if Available)

NOT APPLICABLE FOR MANY OF OUR TRIPS

Yes

No

Name of Partner/Spouse (If paying for 2 people)

First Name

Last Name

Shirt Size Participant *

Check 2 options if more than one person

XS

Small

Medium

Large

XL

XXL

XXXL

How did you find out about Wild Med Adventures?

Google Search

WMS Website

AWLS Website

Adventure Medic

Facebook AD

Instagram

Med Forums

Friend

Twitter

LinkedIn

EP Monthly Ad

Other

By checking this box, I confirm that I have read and agree to the cancellation policy stated on the Wild Med website under the specific course I am signing up for. I also acknowledge that Wild Med Adventures recommends travel insurance for all of their trips and that rescue insurance is required for some. *

I Confirm