Registration form for Offbeat Explorers Bike Ride & Trek to Kalavantin Durg

Offbeat Journeys - Lakeside Camping at Lonavala

17th & 18th Dec 2022
Full Name*
Blood Group*
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

E-mail*
Contact No*

Emergency contact person (Family Member Only)*

First Name Last Name
Emergency contact person's mobile Number*
Relation*
Please note - Emergency contact person should be your family member only.

Joining By*
Joining From*
Joining as
Main Rider Details
Bike Model
C C
Pillion Rider Name
Dinner details on 17th Dec (Saturday)*

Declaration
I take full responsibility for being part of this trek/trip.
Offbeat Explorers wont be responsible for any unavoidable circumstances that may arise during the trip/trek and the complete journey.
Signature*
Should be Empty: