Cambodia – Trek to Angkor Wat 16th – 24th November 2019

Registration fee: £200 / Minimum sponsorship: £3,800

Thank you for expressing an interest in Action Cancer’s 2019 Cambodia – Trek to Angkor Wat. In this pack you will find the following information:

Trek itinerary Package costs and inclusions Details of the life-saving services your fundraising will help Action Cancer provide

Fundraising hints and tips

A registration form, medical form and freepost envelope

How taking part in this challenge will make a difference… This is a once in a lifetime opportunity to explore the dazzling green rice-paddies and jungles of Cambodia which are dotted with temples and ruins, villages of thatched stilted houses, and small towns where Buddhist temples

nestle amongst graceful French colonial buildings. By undertaking this challenge you are committing to raise at least £3,800 for Action Cancer. The money you raise will help to provide cancer prevention, detection and support services to people affected by cancer in Northern Ireland. This will most certainly provide positive motivation as you test your physical endurance by trekking up to 94km over 5 days through hills, valleys and dense forests - you will truly be earning every bit of your sponsorship!

- Experience the friendly and humbling local life of the Khmer people - Dive into a little known yet fascinating culture - Witness amazing views and the remains of an ancient civilisation - Be inspired by the UNESCO World Heritage Site of Angkor Wat - Best time to go: October to early March - Duration: 9 days Trekking days: 5 - Distance trekked: 94km - Accommodation: Hotels and camping - Challenge grading: Challenging (1/3)

Day 1: Depart UK

We depart for our flight to Siem Reap.

Day 2: Arrive Siem Reap

Arrive in Siem Reap, meet our local guides and transfer to our hotel. Rest of the day is free for leisure, to either relax or explore. We meet tonight for a briefing about our challenge ahead.

Day 3: Siem Reap to Wat Preash Bat Bun Tham

After breakfast we take a short transfer out of town and begin our trek. Heading south-east across dazzling green rice-paddies and farmland, we pass through several small villages. Cambodia is one of the friendliest countries in South-East Asia and we will get plenty of smiles and waves as we pass! We’re never far from a temple or pagoda and we make time to stop at a couple for a closer look. At the end of the day we catch our short transfer of about 50 minutes to our camp at Wat Preash Bat Bun Tham.

Trekking distance – approx. 20km; 5-6 hours

Day 4: Wat Preash Bat Bun Tham to Svay Leu Leaving our campsite we head towards Kulen Mountain. Veering right after passing a small village, we head out across the paddy fields where we are treated to fabulous views of Phnom Kulen in the distance. Following cow cart tracks, we wind our way towards Beoung Mealea and the fascinating ruins of this little visited temple. We have the opportunity to explore before taking a short transfer to our evenings campsite at Svay Leu Pagoda. There is often a lively local market near the pagoda which offers a real insight into the way of life in this remote area. Trekking distance – approx. 20km; 7-8 hours

Day 5: Svay Leu to Kulen Mountain After breakfast we trek to the top of Kulen Mountain (487m), Cambodia’s sacred mountain. Deeply revered, the local people make pilgrimages to the pagodas and ruins on the mountain top. The mountain forms a high plateau from where there are fabulous views across the forests and fields below. Going west across the mountain we take undulating tracks through the forests and villages, stopping for lunch in Anlong Thom, a small village of stilted thatched houses. Our trek continues to the ‘Big Buddha’. We camp overnight near the falls and we will have time to bathe in the ‘River of 1000 Lingas’ and admire the elaborate carvings in the riverbed itself. Trekking distance – approx. 26km; 7-8 hrs

Day 6 Kulen Mountain to Tbang We set off after breakfast on an old trail, now little-used since the recent construction of a road. We may meet a few local people who still use the path for hunting, cutting lianas and to work on the farms higher in the hills. Our trek continues south-east on a small jungle trail down the mountain. Back on the flat plains we continue on sandy, sometimes muddy tracks. There is little shade as we pass a few villages, local schools and an abundance of pagodas. We will be hot and tired by the time we reach our evening’s campsite, our final goal nearly within reach. Trekking distance – approx. 18km; 6-7 hrs

Day 7: Tbang to Angkor Wat

We enjoy a final breakfast in camp before setting off on the final 10km of our trek to Angkor Wat. The first section of our trek is on a tarmac road before we return to cow cart tracks leading towards the Angkor complex. Reaching the first of our Angkor temples at Prasat Ta Som, we then load up into the local mode of transport and journey in style to Angkor Wat in a colourful procession of tuk tuks. We pass many temples and ruins as we near our goal – the ultimate reward for our efforts this week include the spectacular walled city of Angkor Thom and the famous Bayon, standing in the exact heart of the city. Adorned with fabulous wall carvings and mysterious giant faces, the Bayon is a real highlight of our challenge. We then continue to the magnificent 12th Century Angkor Wat. It is worth climbing the remarkably steep and narrow steps of the central spire for the unparalleled view over the whole temple. We are free to explore the temple complex until sunset, when we transfer to our hotel by bus. We toast our achievement with a celebration dinner in a local restaurant.

Trekking distance – approx. 10km; 2-3 hrs

Day 8: Explore Siem Reap We have a free day to explore Siem Reap before transferring to the airport in time for our flight home.

Day 9: Return to the UK Land. (Please note: this is a complex itinerary and strictly subject to change)

A non-refundable registration fee of £200 is required to hold your place on this trek.

Each participant is required to raise a minimum sponsorship of £3,800.

80% of the sponsorship will be required 12 weeks before the trek departs:

£3,040 due by Friday 23rd August 2019

The outstanding balance is due 4 weeks before the trek departs: £760 due by Friday 18th October 2019

Return flights from Belfast/Dublin airport to Siem Reap

including Airport Taxes and Fuel Surcharges

All accommodation – 2 nights in hotels, twin share and

camping whilst on trek

Camping equipment – tents and mattresses

Professional, local English speaking guides

Meals (breakfast, lunch and dinner) starting with dinner

on day 2 through to dinner day 8

Entrance fees to Angkor Wat

Drinking water

Global Adventure Challenges Leader from the UK

UK Doctor to travel with group

Global Adventure Challenges Medical Kit

Action Cancer representative

Lunch and dinner on day 9

Visa for Cambodia (approx. £20 per person

and can be obtained prior to arrival, or on

arrival. Participants will need 2 passport

seized photo’s to obtain this)

Tips and Gratuities

Alcoholic drinks

Travel insurance

About Action Cancer

This trekking challenge offers a once in a lifetime adventure experience, as well as an amazing sense of achievement at having raised vital funds for Action Cancer, Northern Ireland’s leading, local cancer charity. Our mission at Action Cancer is to save lives and support local people through cancer awareness, prevention, detection and support services. We provide the following services: • Digital Breast Screening • Support & Therapeutic Services • M.O.T. Health Checks • Health Promotion Programmes In Northern Ireland someone receives a cancer diagnosis every hour of every day and one in two of us will receive a cancer diagnosis in our lifetime. While cancer rates are on the increase, early detection and improved treatments mean that survival rates are improving thanks to the vital work of charities like Action Cancer. We deliver our services from Action Cancer House, Belfast, and on-board our mobile unit, the Big Bus, which travels to 225 locations throughout Northern Ireland annually. This year, Action Cancer will provide early detection, support and prevention services to over 50,000 people, including breast screening for over 9729 women. For every 1,000 women screened 6 cancers were detected.

How your money will help We rely on the people of Northern Ireland to raise money for us. Without your help, we wouldn't be able to save lives and support local people affected by cancer. We receive no government funding and must raise over £4 million per year to operate our life saving services. The funds you raise by participating in this trek will help those facing the challenge of receiving a cancer diagnosis or undergoing treatment as well as their families.

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Raising Sponsorship Money All trek participants will receive a fundraising pack full of information, ideas and helpful suggestions designed to assist you in smashing your fundraising target of £3,800. The Action Cancer Events Team who will also be on hand every step of the way to offer support and guidance throughout your fundraising journey. Some of the things we can provide include:

Branded T shirts

Design and print of posters/tickets for fundraising events Request letters for raffle prizes and collections Sponsor Forms Awareness brochures Branded collection buckets, banners, balloons etc. for events Advice on setting up Just Giving page Bag packs in a local supermarket throughout August

Who Can Take Part in the trek? This trek is open to anyone over the age of 18 or 16+ if accompanied by a guardian. You must be physically fit and well enough to take part in the challenge. All participants are required to complete a medical form. In some cases, a doctor’s signature may be required to confirm your ability to participate.

Action Cancer Contacts If you have any questions please do not hesitate to contact the Action Cancer Events Team. Lynn Sanderson, is your Action Cancer Treks & Events Executive, and is more than happy to answer any queries you might have. You can contact her as below:

Direct Line – 028 9080 3347 Email: lsanderson@actioncancer.org

How do I register to take part? We have a limited number of places available so recommend you register as early as possible. Our travel partner for this trek is Global Adventure Challenges who have many years of experience in leading treks all over the world. To confirm your place on this fantastic adventure simply complete the registration and medical forms included in this pack and return them along with a photocopy of your passport and your non-refundable £200 registration fee in the enclosed freepost envelope.

Registration Form – Overseas Challenges Cambodia – Trek to Angkor Wat

16th – 24th November 2019

Personal Details (As they appear on your passport)

Title (Mr/Mrs/Miss/Ms):..........................................................................................................................

Surname: .................................................................................................................................................

Forenames: ..............................................................................................................................................

Address:

..................................................................................................................................................................

...................................................................................... Postcode: ..........................................................

Daytime Telephone No.............................................................................................................................

Evening Telephone No:.............................................................................................................................

Mobile Telephone No:..............................................................................................................................

Email Address: .........................................................................................................................................

Please circle your preferred t-shirt size: XS S M L XL XXL

Date of Birth: ................................................. Nationality: .....................................................................

Marital Status: .........................................................................................................................................

Passport Number: ....................................................................................................................................

Place of Issue: ..........................................................................................................................................

Passport Start Date: ............................................. Passport Expiry Date: ................................................

Would you like your contact details to be circulated to the group? Yes/No

Note: your passport must be valid for at least six months after you return from the challenge.

Please include a photocopy of the page in your passport containing your photograph.

Dietary Requirements

Please provide FULL details of any special dietary requirements or allergies you might have in the

space below.

..................................................................................................................................................................

..................................................................................................................................................................

..................................................................................................................................................................

Accommodation

Accommodation will be on a room sharing basis. Please give the name(s) of anyone with whom you

have agreed to share below:

..................................................................................................................................................................

The Challenge Event

How did you find out about the challenge event? (Please give details)

..................................................................................................................................................................

Insurance

Travel insurance is an essential requirement of this trip. It is recommended that your travel

insurance cover be taken through Global Adventure Challenges but other providers are available. It

is your responsibility to arrange your travel insurance and send the Provider Name, Policy Number

and Emergency 24/7 contact telephone number to your Treks representative on

trek@actioncancer.org.

Agreement and Declaration

I agree to the Global Adventure Challenges Overseas Bespoke Challenge Booking Conditions,

(available on request) and enclose payment for my registration fee.

You must enclose a registration fee of £200 for each application (payable to Action Cancer, this is

non-refundable under any circumstances).

You must raise a minimum of £3,800 sponsorship (excluding deposit) for Action Cancer, £3,040 due

by 23rd August 2019 and the remaining 20% (£760) due by 18th October 2019.

If you are unable to meet the sponsorship requirements you will forfeit your place on the trek.

All funds raised should be made payable to Action Cancer.

All flights will be booked through Global Adventure Challenges.

Your passport must be valid for at least six months from the date of your return to the UK.

On receipt of your final payment, you will receive further details on your trip including departure

and flight details.

All participants MUST complete the enclosed medical form. If you answer yes to any of the

questions you must have the form signed by a doctor to confirm you are physically well enough to

complete the challenge, that your general state of health and fitness is good and that you will take

responsibility for yourself.

You accept that all instructions given to you on the challenge must be observed for your own safety.

You will certify that all information you have provided on this registration form and any other forms

is correct to the best of your knowledge.

You must have adequate insurance for this challenge. This must be sent to Action Cancer 6 weeks

prior to departure.

I understand and agree that my personal data may be processed and/or transferred outside of the

European economic area in order for the full and proper performance of the challenge contract. I

understand that Global Adventure Challenges will only transfer to the extent required.

By ticking this box, I confirm that I am happy to receive emails and direct marketing from Action

Cancer (you can stop receiving emails at any time by selecting unsubscribe in the email).

Participant’s Signature: ...........................................................................................................................

Date: .......................................................................................................................................................

Payment Details *Please delete as appropriate

*Cheque enclosed totalling £200 (the registration fee, which is strictly non-refundable, should be

made payable to Action Cancer)

*Please debit £200 from my credit/debit card (details below)

Name (as it appears on the card)

.......................................................................................................................................

Type of card (e.g. Visa, Delta, etc.) ..........................................................................................................

Card Number ............................................................................................................................................

Valid from Date: ........................................................ Expiry Date: .........................................................

Issue No. ........................... Security No. (last 3 digits on reverse of card) ..............................................

medical

questionnaire

Global Adventure Challenges Ltd

Red Hill House, Hope Street, Chester, Cheshire CH4 8BU

www.globaladventurechallenges.com – customer.care@globaladventurechallenges.com

Please complete this medical questionnaire. Your answers will be treated in the strictest confidence in accordance

with the Data Protection Act and our policy is to encourage and support as many people as possible to take part in

our challenges. We request medical information from you in an endeavour to minimise risk to all participants, and

for that reason we ask that you disclose all your medical history. Depending on the answers given you may need to

get your Doctor to sign and stamp this medical declaration. If you are 64 years of age or over at time of travel this

form must be authorised by your Doctor regardless of the answers given.

Please complete all fields by hand, forms filled in electronically cannot be accepted and will be returned.

Personal Information

Name and Date of Challenge

Name Date of Birth

Height Weight BMI (if known)

Blood Type (if known) Normal Blood Pressure Reading (if known)

Do you have any dietary requirements i.e. Vegetarian, vegan, gluten free? If so please provide FULL details below:

Medical History – Do you have a history of suffering from any of the following conditions (please circle)? If you have answered YES to any of the questions we may require you to get your GP to sign and stamp the reverse of this form. Alternatively we may request further information and/or ask you to sign a medical disclaimer.

Asthma, bronchitis or shortness of breath Yes / No Diabetes Yes / No

Bleeding or other blood disorders Yes / No Cancer Yes / No

Any form of lung disease Yes / No Epilepsy, seizures or convulsions Yes / No

Severe head injury Yes / No Drug or alcohol abuse / dependency Yes / No

Physical or other disability Yes / No High/raised blood pressure and/or heart

disease including: heart attacks, angina,

cardiac or vascular related surgery and

irregular heart rates and rhythms

Yes / No

Ulcers or ulcer surgery Yes / No Bowel disorder Yes / No

Arm or leg problems including but not

limited to fractures, tendon, ligament or

cartilage damage

Yes / No Are there any other medical issues not

covered which are relevant to your well-

being on the challenge

Yes / No

Underactive thyroid Yes / No Recurring migraine headaches Yes / No

Overactive thyroid Yes / No Recurring back problems/surgery Yes / No

Hearing loss or problems with balance Yes / No Blackouts or fainting Yes / No

Behavioural or mental health illness

including but not limited to depression or

psychosis

Yes / No Do you suffer from any phobias

(claustrophobia, heights, water etc.)

Yes / No

Are you pregnant Yes / No Any type of hernia Yes / No

Are you awaiting

tests/investigations/results/surgery

Yes / No Are you suffering from or are a carrier of

any infectious disease

Yes / No

Have you been hospitalised within the

past two years

Yes / No Do you suffer from any allergies (nuts,

penicillin, sea food, hay fever etc.)

Yes / No

If you have answered yes to any questions in the Medical History section please provide further information below

Global Adventure Challenges Ltd

Red Hill House, Hope Street, Chester, Cheshire CH4 8BU

www.globaladventurechallenges.com – customer.care@globaladventurechallenges.com

If you answered yes to the question regarding Asthma please answer the following questions

Have you ever had an asthma attack? If so how often do

you have an attack and when was the last time?

What triggers your Asthma?

Have you ever needed hospital treatment for an asthma

attack?

What medication / inhalers do you currently use and

how often?

Medication – please list below any prescription or non-prescription medication you may be taking including the

dosage and frequency. Please use BLOCK CAPITALS to fill in this section.

Medication Dosage & Frequency

Medication Dosage & Frequency

Medication Dosage & Frequency

Medication Dosage & Frequency

Medication Dosage & Frequency

Next of Kin Details – this must be someone who is not participating in the same challenge

Full Name Relationship

Address

Post code

Telephone No Mobile No

Doctor’s Authorisation – this section must be completed if you are 64 years of age or over at time of travel, or we

have requested your GP to sign and stamp this section due to the information you have provided above.

I confirm I have read the itinerary of the challenge detailed on this Medical Questionnaire and understand that

Global Adventure Challenges will provide experienced personnel to lead the event who are first-aid trained,

however the challenge may be a considerable distance from any hospital back up. In addition I have read this

medical form and I can confirm that the information given by the participant is correct and no significant

information has been withheld. In my opinion, this patient is currently fit and healthy both mentally and physically

and able to participate in the challenge.

GP Name

Date

GP Signature

GMC No

Practice Tel No

Practice Fax No

Practice Stamp:

Participant Declaration - It is a condition of joining any Global Adventure Challenge that in cases of emergency the

Global Adventure Challenges representative has your authority to arrange any necessary medical or surgical

treatments and to sign any required form of consent on your behalf.

I hereby give permission for the Global Adventure Challenges company's medical advisor to discuss medical

conditions relevant to this challenge with either my Doctor or hospital specialist.

I also confirm that I will advise my insurer of any medical condition. Should I fail to do this, I understand that I will

be liable for any medical costs incurred whilst on the challenge as a result of my condition. If I develop any new

medical conditions or experience worsening of existing conditions after returning this form, I agree to inform Global

Adventure Challenges immediately.

Print Name Date

Signature