Complete the form below to start the Aconcagua Best Experience.

Personal Info

All fields marked with an asterisk (*) are required.
How did you hear about us? *
Name *
Last Name *
Gender *
Birth Date *
Type of ID *
ID Number *
Nacionality * 
E-mail *
Tel/Fax *
Mobile phone *
Profession / Occupation *

Address

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Street *
Number *
Floor
Apartment
Zip Code *
City *
State/Province *
Country *

Emergency

In case of Emergency contact:

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Name *
Relationship *
E-mail *
Tel/Fax *
Mobile phone *

Insurance

Company
Type of insurance
Policy number
E-mail
Tel/Fax

Medical Info

All fields marked with an asterisk (*) are required.
Blood Type *

Have you ever suffered from any of these conditions?

Hypertension * Yes / No

Type Controlled with medicine Controlled without medicine Not controlled

Medicine for Hypertension

Allergies * Yes / No

Type of Allergies

Diabetes * Yes / No

Type of Diabetes

Smoking * Yes / No

Daily N° of cigarettes

Breathing problems * Yes / No

Type of Problem

Cardiac condition * Yes / No

Type of condition

Seizures * Yes / No

Date of last seizure (dd/mm/yy)

Pregnancy * Yes / No

Stage of pregnancy

Did you take some medicine? * Yes / No

Medicine details

Spine problems * Yes / No
Previous Luxations * Yes / No
Did you use glasses? * Yes / No

Acute Mountain Sickness (AMS) * Yes / No

High Altitude Pulmonary Edema (HAPE)* Yes / No

High Altitude Cerebral Edema (HALE) * Yes / No

Are you under medical supervision? * Yes / No

General Health * Very Good / Good / Regular / Bad

Altitude above sea level at your currently residence *

Maximum altitude reached walking in the mountains *

Any other health condition? *

Diet

All fields marked with an asterisk (*) are required.
Type of diet * Standard / Special

Diabetes/Celiac/Vegetarian

Appreciations

Note: At Inka Expeditions our cooks perform a varied and nutritious menu to satisfy the energetic requirements of mountain activities. We have the possibility to adapt our menus to other pre-established according to the dietary restrictions of each client. Please be aware that any specific food wish to eat on the mountain must be provided by you. If you choose to bring from your country of origin, please get advice from regarding the entry of food regulations of Argentina and specific prohibitions of Mendoza.
(Mendoza) Iscamen www.iscamen.com.ar
(Argentina) Senasa www.senasa.gov.ar

Experience

Mountain experience *

Summit until 5000 mts
Which ones?

Summit until 6000 mts
Which ones?

Summit until 7000 mts
Which ones?

Summit more than 7000 mts
Which ones?

Other experiences

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