KILIMANJARO MARATHON & HALF MARATHON & 5K TOUR 2009
					RUN & TREK 
Please complete the form below/one form per person.  Send along with a copy of your passport
photopage (if you currently have your passport/ otherwise when you obtain passport send a copy).

Please make $300.00 deposit check payable to: 
Kathy Loper Events, 7801 Mission Center Court, Suite 204, San Diego, CA 92108.

Second deposit of $300.00 due November 1, 2009.  

Balance due 20 December 2009  (final invoice sent by 01 December 2009)

Please Print: (Name as it is or will appear on your passport)

Name_______________________________________________________________
	(first)						(last)

Roommate___________________________________________________________

Address:____________________________________________________________

City/State/Zip_________________________________________________________

Phone (area code/number) 
Home _______-_______________Fax_______-_______________________

Business______-______________Fax_______-_______________________

E-mail:________________________________________________________

Age on February 28, 2010 (race day)_______		Birthdate___MO___Day___YR

Northwest Departure City_________________________________________	
NW air add-on from Southeast $140. Mid-West $260.  South & Southwest $220.  West Coast $180.               
										           Ask for details!
Kilimanjaro Basic Run & Trek Tour Program:  
	Wed 24 Feb-Tues 09 Mar, 2010                                                                   $3995.00
	(Based on USA Northeast Departure/double occupancy
           rate per person based on minimum of 20 participants)    

         Single Supplement Room & Trek/tent				                     $  220.00

Travel Protection Plan from  						                  $  150.00
Covers Trip Cancellation, Medical, Emergency Evacuation, Baggage.
(must be paid within 14 days of deposit/pricing varies due to total tour program & age)
	A travel protection travel plan with medical coverage/evacuation is 	required for all people on the trek. 

________Yes send information				_______No Not interested

Kilimanjaro Event:       Marathon	       Half-Marathon     5K     Spectator     (circle one)

T-SHIRT:  	   	   S	    M	    L       XL    (circle one)

Kathy Loper Events	           619-298-7400            www.kathyloperevents.com