Horizons Unlimited · Churchill River Canoe Outfitters Box 1110 · La Ronge, SK S0J 1L0 · Canada · Toll-free: 1-877-511-2726 Horizons Unlimited Wilderness Services Inc. Pre-Trip Questionnaire

Please complete as soon as possible and forward to Horizons Unlimited at the above address at least 2 weeks prior to the start of the Expedition.

Trip Name _____________________________________________________________

Name of Applicant _______________________________________________________

Occupation: ____________________________________________________________

Travel Information

Where will you be meeting us: ______________________________________________

How are you arriving: Driving: ___ Bus: ___ Scheduled flight: ___ Other: __________

If you are arriving by public transportation to La Ronge, would you like us to meet you there and transport you to Missinipe? _____ ($120/group)

Date/Time of Arrival: _____________________________________________________

Date/Time of Departure: ___________________________________________________

Contact Information

If for some reason (e.g. weather) the completion of the trip is delayed, you may want us to contact a spouse, relative or friend to advise them of the delay. Delays are rare, but in this event whom would you like us to contact?

Contact Name: _________________________________________

Telephone (day): _____________________ (evening): ___________________________

E-mail address: _________________________________________

Food/Diet Information

Is there anything you cannot tolerate eating that may be on the menu? _______________

Any food allergies? _______________________________________________________

Are you on any special diet? ________________________________________________

Are you partial to ___ tea, ____ coffee, ____ hot chocolate or ____ juice crystals?

Equipment Information

Are you bringing any of the following: ____ paddle, ____ PFD or ____ tent?

Please check the items you need to rent:

_____ sleeping bag ($50/week) ____ thermorest ($35/week)

Please forward this to Horizons at least 2 weeks before the start date of the trip. In this way we have the time to make any changes necessary to the menu.

We look forward to having you as a guest on our Expedition. We at Horizons Unlimited Wilderness Services will do everything we can to make your holiday with us an enjoyable one. We will see you soon.

Thank-you!