Please register me on the week commencing:

Sunday Choose a departure August 15 (Waitlist) August 22 (Waitlist) August 29 September 5 September 12 September 19 September 26 October 3 October 10 2010. (Remember a seperate Form for each weekly trip)

I am eligible to Participate in the Choose a Category of Participation Internship Program. Youth Internship Program.

I am eligible to Participate in this Category because:
Provide brief supporting information here...

I wish to pay Choose an amount Aust $550 Deposit - Internship Program. Aust $1950 Full Payment - Internship Program. Aust $550 Deposit - Youth Internship Program. Aust $1450 Full Payment - Youth Internship Program. My Final Payment.

I am paying by: Cheque | Money Order | Visa | MasterCard |

Card No Expiry Date
Name on Card

I have carefully read and understand the How to Participate Information.

I acknowledge the balance is due and payable 90 days prior to joining the expedition.

I declare that I am physically fit to particpate as an Intern aboard the 2010 Expedition.