SPS Trekking Club
Name _________________________ Father Name________________________
N.I.C.#: _______________ Next of kin Name __________ D.of Birth._________
Occupation ____________ Occupation Address __________________________
Email if any ____________________________ Ph.#: ______________________
Interests/Hobbies. __________ __________ __________ __________ _______
Past experience outdoor in Trekking __________________________________________________
Longest adventure undertaken. __________________________________________
Are you fully equipped with Trekking materials? ___________________________
Are there any food you can not eat/digest?_________________________________
Has any member of your family been a trekker? (Give detail)__________________
By two senior members of the club or Head of Educational Institution.
Name. __________________________________ Name. __________________________________
Address: ________________________________ Address: ________________________________
Phone.# __________________ Date___________ Phone.# __________________ Date___________
Sign ________________ Remarks.____________ Sign ________________ Remarks.____________
Physical and Medical particulars:
Height (cm) Weight (Kg) Foot Size (cm) Chest Size (cm) Blood Group
Physical or medical disability if any (Attach Details: __________________________________
Built Weak Medium Strong Well Built
Physical fitness status ____________________.
Medical fitness status (please provide details of medical problems if any in your own interest).
SPS Trekking membership is open to all with a minimum age of 16 years. Who
are interested in the promotion and furtherance of action oriented activities in the
Category Amount Remarks
Member ship 500 Initial Subscription
Students 40 Monthly Subscription
Regular Member 50 Monthly Subscription
Associate Member 75 Monthly Subscription
Executive Member 100 Monthly Subscription
Honorary Member 500 Annual Subscription
1. Having familiarized myself with the aims and objectives of the SPS Trekking
Club. I agree to support its activities in the interest of the youth and people
from all walks of life in the country.
2. I hereby give my consent to attend course/expedition or other activity
organised by SPS Trekking Club and gives my permission for any emergency
anaesthesia, operation, hospitalization or other treatment, which become
necessary during the course of this activity.
3. I shall not tender/put forward any claim what so ever, for any in
convenience, injury, physical harm or expenditure in cured during the
course of activities organised by the club.
4. I have provided the above information complete and accurate to the best of
my knowledge. I realize that failure to disclose any information could
result in serious harms to my self and fellow members of the club. I agree
not to hold SPS Trekking Club responsible for any harm to my self due to
provision of relevant information. In case if any of the information
provided above proved wrong then SPS Trekking Club has the right to terminate
my club membership.
5. I shall intimate the SPS Trekking Club in writing if there is any change in the
above mentioned information/particulars.
Category of membership applied
Introduced by (Name): ______________ Applicant’s Signature
For official use only
Approved Not Approved Pending