Movember Mt. Kilimanjaro Application

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Thank you so much for your interest in hiking Mt. Kilimanjaro with Movember. Please note we have limited spots for this trek and we are currently only accepting US participants at this time. The application below will be used to help us pick our trek team.

If you have any questions, please reach out to Keith (keith@movember.com)

Email *

Full Name *

Phone Number *

Address line 1 *

Address line 2

City *

State *

Zip Code *

Date of birth *

YYYY

Please make sure to watch the information session video and review the related documents before you continue with your application:
https://movember.box.com/s/uos9uxtqb1cjrj6qkreulunhxgqsgcby

Did you attend the information session or watch the info session video? *

Yes

We often have more applicants than we have spots for, the more thought you put into your application, the better your chances.

Why do you want to participate in this trek and raise funds for Movember? *

What part of Movember resonates with you the most? *

Are you or will you be physically up to the challenge of climbing a mountain? *

Yes

If you are looking to do this trek with a friend, they also need to apply AND meet the fundraising minimum. If your friend is not picked do you still want to do the trek? *

Yes

I'm not applying with a friend

What is your friend's name (first and last please)?

Tell us about your fundraising history outside of Movember? *

What are your fundraising plans to reach the $10,000 minimum? Please be as descriptive as possible. *

Are you able to take at least 11 days off of your work? *

Yes

Other:

Anything else we should know?

Trip Application and Medical Form

Please take a moment to read through Embark Exploration Co.'s Trip Application and Medical Form found here: https://movember.box.com/v/KiliTrekSampleApplication

You DO NOT need to fill the Application and Medical Form out at this time. If you are selected to join the trek, you will be required to fill it out then

Have you read the Embark Trip Application and Medical form? *

Yes

Do you feel comfortable with everything on the Trip Application and Medical Form? *

Yes

If you answered "No" to the above, please explain

By clicking submit you agree that you are comfortable with the physically demanding nature of this trek. You understand that you are applying for one of a limited number of spots. You understand that you will be responsible for your own airfare, travel insurance, travel visas, tips for the crew, etc. You understand that applying for trek does not guarantee you a spot on the team. You also accept the Movember Terms and Conditions and Privacy Policy. Please review these policies for information on how we collect and use data. https://us.movember.com/terms and https://us.movember.com/privacy

A copy of your responses will be emailed to the address you provided.

Submit

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