Trip Registration Desired trip Desired trip dates Name * First Name Last Name Email * Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth Date MM DD YYYY Emergency Contact Name Emergency contact phone number Relationship to Emergency Contact What Gender to you identify with? Height/Weight? Health Area: Please briefly describe your climbing and/or skiing experience as it relates to your guided trip Rate your general physical fitness Excellent Good Fair Poor Have you been hospitalized or ill in the last 12 months? Are you taking any medications regularly? Do you have anaphylaxis allergies Yes No Do you have Asthma Yes No Do you have diabetes? Yes No Do you have Heart Disease Yes No Do you have Seizures? Yes No If you clicked west to any of the previous questions please elaborate. How long have you had this condition? Is it under control? Do you take medication for the condition? If allergy related, what are you allergic to? * Do you have problems with your hearing or vision? If yes please describe Do you have muscular or skeletal deficiencies or recent surgeries that might hinder your mobility and ability to participate in your guided trip? Please describe? Is there any other medical or physical concern that might impact your ability to fully enjoy your guided experience? If yes please explain? Thank you!