Wilderness Pakistan
Adventure with those who dare.
Membership Form
PERSONAL DATA
Salutation
Mr.
Miss
Mrs.
Dr.
Name *
Father's Name *
Nationality
Afghanistan
Albania
Algeria
American Samoa
Anddorra
Angola
Anguilla
Antartica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaidjan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnis-Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Combodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Chrismas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
EI Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
Former USSR
France
France (European Territory)
French Guyana
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe (French)
Guam
Guatemala
Guinea
Guinea Bissau
Guyana
Haiti
Heard and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithunia
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldavia
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar, Union of Burma
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
Neutral Zone
New Caledonia (French)
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Nothern Mariana Islands
North Korea
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Polynesia (French)
Portugal
Qatar
Reunion (French)
Romania
Russian Federation
Rwanda
Saint Helena
Saint Kitts & Nevis Anguilla
Saint Lucia
Saint Pierre & Miquelon
Saint Tome & Principe
Saint Vincent & Grenadines
Samoa
San Marino
Suadi Arabia
Senegal
Seychelles
S. Georgia & Sandwich Islands
Sierra Leone
Singapore
Slovakia
Slovak Republic
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
Spain
Srilanka
Sudan
Suriname
Svalbard & Jan Mayen ISlands
Swaziland
Sweden
Switzerland
Syria
Tadjikistan
Taiwan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos Islands
Tuvalu
Uganda
UK
Ukraine
United Arab Emirates
Uruguay
USA
US Minor Outlying Islands
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands (British)
Virgin Islands (US)
Wallis & Futuna Islands
Western Sahara
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
NIC *
Occupation
Qualification
Present Address
Permanent Address
Phone (include Area Code) *
Cell (include Code)
Email *
Languages (Please specify)
Physical & Medical Particulars
Blood Group
A+
A-
B+
B-
O+
O-
AB+
AB-
Height (cm.)
Weight (kg.)
Built
Weak
Medium
Strong
Well Built
Disease (If any)
Special Interests
Mountaineering
Rock Climbing
Rifle Shooting
Riding
Mountain Biking
Rafting
Moto Para-Gliding
Hiking/Trekking
Canoeing
Swimming
Other (specify)
What technical or educational certificates/testimonials do you hold (Please Specify)
Reference
Name, address and telephone of at least one reference who can contacted for the verification of antecedents of the applicant *
