APPLICATION FORM
RUNNING CAMP WITH JULIA BLEASDALE: 5-8 NOVEMBER 2015
ABOUT YOU
1. First Name
2. Surname
3. Email
4. Phone (incl. country code)
5. Date of Birth
6. Nationality
7. Passport number
8. Residency status in Ethiopia:
INFORMATION FOR LIMALIMO LODGE
1. Do you have any dietary requirements? Yes:
No:
If yes, please detail: _____________________________________________________
2. Would you like to share a:
Twin Room
Double Room
3. If applicable, please provide the name of your friend/partner you’d like to share with:
______________________________________________________________________
If left blank, you will be partnered with another runner of the same sex.
4. Will you be arriving at Gondar Airport on the ET114 Ethiopian Airways flight?
Yes:
No, I’ll be arriving on ET flight
5. Will you be departing from Gondar Airport on the ET115 Ethiopian Airways flight?
Yes:
No. I’ll be departing on ET flight
6. Would you like to extend your stay beyond 5-8 November?
Yes:
No:
INFORMATION FOR JULIA BLEASDALE
1. Have you run at altitude before? (Note Limalimo Lodge is situated at 3,000 metres.)
Yes:
No:
2. How would you classify your running experience?
I am new to running, but generally fit:
I have some experience with running long distances:
I am an experienced runner:
3. If you have taken part in competitive runs such as a 10k, half or full marathon, please
provide details including the year, distance and your finish time:
a. _________________________________________________________
b. _________________________________________________________
c. _________________________________________________________
4. Do you have any health conditions we should know about, such as asthma, a heart
condition, back or joint complaints? If so, please provide all details. This won’t stop you
taking part, but it’s essential we know all relevant details:
a. _________________________________________________________
b. _________________________________________________________
c. _________________________________________________________
REGISTRATION
The running camp is $600 per person. We require a 50% deposit by 30 June 2015, with the
remaining 50% due on Thursday 24 September 2015, 6 weeks before the camp. Due to the
specialised nature of this event, deposit payments are non-refundable (however you may
substitute your position with a friend if you wish).
Please see the full terms and conditions for cancelation details, and all details on what is
included in this rate. By signing this form, you’re agreeing to all terms and conditions.
Payment should be made via electronic transfer, in USD or GBP. On receiving this form, you
will be sent the bank account details for Limalimo Lodge. On receipt of the 50% deposit, we
will confirm your place on the running camp.
Print Name:
____________________________________________
Signature:
____________________________________________
Date:
____________________________________________
Thank you for signing up to be part of this exciting opportunity.
We look forward to being in touch. If you have any questions, please get in touch via:
reservations@limalimolodge.com
Page 2 / 2