Long Signup Form

* Indicates required field

Name *

First

Last

Member # *

Date of Birth *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Work Phone *

May we contact you during work hours? *

Yes No

Home Phone *

Cell Phone *

May we contact you via e-mail with trip information? *

Yes No

If yes - your Email address *

Skiing Ability *

I understand that I must purchase my own trip insurance. *

Please check that you understand

Meal Preferences: Dietary Restrictions: *

Yes No

If "yes" please explain: *

Rooming Preferences: *

If you don't have a roommate, the trip leader will attempt to locate one for you. However, this cannot be guaranteed. If we are unable to find a roommate for you, single supplement charges will apply.

Emergency Contact (NOT on trip):

Name: *

Relationship: *

Cell *

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