The Reservation Form and Release of Liability & Assumption of All Risk must be completed, signed, and returned as soon as
possible to secure your space, even if you have already charged your deposit by phone. For two or more adult participants,
please fill out one application for each person.

Applicant's Name(s):(As it appears on passport)_____________________________________________

Occupation:_________________________________________________________

Address:_______________________________________________________________________________

City/State/Zip:_________________________________________________________________________

Phone: (Home) _______________________ (Cell)________________________ Phone: (Office) _________________________

E-mail address (Primary): _________________________________________________________________________

E-mail address (Secondary): _______________________________________________________________________

Previous JHRJ client: Yes _____ No _____ Most recent trip: _____________________________________

Name of Trip:_________________________ Departure Date: ________________________

2nd Choice Trip: _______________________ Departure Date: ________________________

No. of Adults: _______ Ages:_________ No. of Youths: ______ Ages: __________

Weights of Adults: _________________ Weights of Youths:__________________
*For safety and logistics reasons reasons (lifejacket sizing). it is important to specify weights.

Adult Fare: $______________________ Youth fare: $_______________________

Amount enclosed:$__________________

I wish to charge the Deposit for the Trip on: Visa___ Mastercard___

Visa/Mastercard Card #:_____________________________________________________________

Exp. Date:__________ 3 No. Security code_back of card: _________ Billing Zip Code ____________

Signature: __________________________________________________________________

In Case of Emergency please notify:

Name:_________________________________________________

Phone: (Home) __________________ (Cell)____________________ Phone: (Office) ____________________

Address:_______________________________________________ Relation: ____________________________

City/State/Zip:_____________________________________________________________________________

Trip Cancellation and Travel Insurance:
The deposit includes both a deposit for the trip land cost and full payment for trip cancellation and travel
insurance. Please see the accompanying "Terms and Conditions/Insurance" area of the web site for the
exact cost and details of this group discounted insurance.  In our written material, please refer to the
supplement entitled “About Our Trips/Booking Information”. If you choose not to accept this insurance,
the entire deposit will be credited toward the trip land cost.

___ I accept the trip cancellation and travel insurance as offered

___ I decline the trip cancellation and travel insurance as offered

Please include the following if you are joining an Alaskan Tatshenshini Trip only

Marital Status: ____________ Sex: ________ Age:_________ Height: __________ Weight:___________

Passport No.: ____________ Place of Issue:_________________________ Date of Issue:________

Exp. Date of Passport: ______________ Birthplace: __________________________Birthdate:__________

Citizenship:_______________________ Occupation:___________________________

Hotel Accommodations:

____ I am willing to share a double room ____ I wish to share with: (name) ________________________

____ I prefer to room with a smoker ____with a nonsmoker ____ either

____ I prefer a single room and tent (if available) and will pay the extra supplemental cost

Describe your health (any special considerations, dietary restrictions, special medications or other
personal needs):

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________


Describe in detail your previous outdoor experience (i.e., rafting, trekking, backpacking) and indicate any
previous trips taken with us:

________________________________________________________________________________________

________________________________________________________________________________________

Please indicate briefly your own reasons for going on this trip:

________________________________________________________________________________________

________________________________________________________________________________________

Please list any additional informaiton about yourself that might be helpful in conduting this trip:

________________________________________________________________________________________

________________________________________________________________________________________

If you have lost your copy of our color catalog — never received one — or want one sent to a friend - give us
a call or mail us this form.

Any Questions? 1-800-786-1830 or (415) 868-0585 or
e-mail: jhrj@riverjourneys.com

For Further Information: Please phone us or fill out and mail us the following form. We will send you a
Trip Profile, which has detailed information concerning daily itineraries, leadership, trip qualifications,
arrangements, reservations, waitlisting, cancellation and refunds, air travel, tier-pricing, cancelled trips,
trip grading, covered expenses, age limits, insurance, and educational credit. Most of this material has been
covered in the pages of this website.

Yes! I'd like more information! Please send me detailed Trip Profiles for the following trips:

Trip: ____________________________________

Trip: ____________________________________

Trip: ____________________________________

Trip: ____________________________________

Yes! I'd like to have someone in your office call me.

Name____________________________________________________________________________________________________

Phone: (Home) _______________________ (Cell)_________________________ Phone: (Office) ________________________

Please list any folks who might enjoy our catalog or receive our e-mail newsletters:

Name:______________________________________________________________________________________

City/State/Zip:______________________________________________________________________________

E-mail Address: ______________________________________________________________________________

Name:______________________________________________________________________________________

City/State/Zip:______________________________________________________________________________

E-mail Address: ______________________________________________________________________________

How did you discover JHRJ? ____________________________________________________________________