CB 2015 Application

Application for the Cordillera Blanca 2015 Expedition

Send Applications to:

John All, PhD, JD

Email: [email protected]

Due: May 15, 2015    Note: Applications will be considered in the order received. 

  1. Please include a copy of your passport photo page.  Also, please include 1 or 2 pictures that can be used on our webpage and a 3 - 4 sentence description of who you are and why you are participating in this expedition for potential use on our webpage.  Also, please let us know if there is any else that we need to know about you or your application.
  2. Contact Information: (Some details are required by the Peruvian Government for our research permit in Huascaran National Park).
  3.  Applicant Name (as on Passport):
  4. Preferred Name:
  5. Mailing Address:
  6.  Home Phone:
  7. Cell Phone:
  8. Email Address:
  9. Skype address:
  10.  Emergency Contact Name:
  11. Emergency Contact Phone:
  12. Emergency Contact Email:
  13.  Passport Number
  14. Passport Country:
  15. Birthday:
  16. Professional Affiliation:
  17. AAC Member Number:
  18. AAC Section Affiliation:
  19. Experience and Skills: Please use as much space as necessary to fully answer these questions.  (Note: We know that not everyone will have experience in all of these areas, we are looking for a blend of talent on the expedition –climbers, scientists, and anyone else who wants to help with conservation in the Cordillera Blanca.)
  20.  Mountaineering Experience Please include mountain/route name, location, highest elevation, and year - and please be most detailed about your climbing over the past few years.  Include (in order of importance) expedition mountaineering, alpine ice, ski mountaineering, alpine snow, multi-pitch ice, and multi-pitch rock climbing.
  21. Please indicate if you have advanced skills with photography, web design, first aid, rescue, videography, or use of a GPS.
  22. Science experience: Please provide a description of your environmental science or engineering experience.
  23. Medical Experience:  Please provide a description of your medical training.
  24. Preferred Dates: For more information regarding each Trip as currently proposed, see the Expedition Schedule. (Note: Participants are expected to arrive early in Huaraz to begin acclimatization and it is preferred that participants climb in at least two of the valleys to maximize the experience):
  25. Expedition Valleys and Dates requested:
  26. Please note that the above reflects our plans for the Expedition as currently contemplated.  Although we don’t currently anticipate any significant changes, please keep in mind that we may modify the scope, schedule and specific plans for the Expedition from time to time to take into account changes in research priorities, site accessibility, route and travel conditions, weather, participant capabilities or other factors.