PARTNERS IN THE PARKS
REGISTRATION FORM

Year Project

First Name
Last Name

Address
City
State/Province
Postal Code
Country

Phone
Email
University/college

PHYSICAL CONDITION  
Check the highest level of physcial actvity that you can comfortaby reach walking and jogging
WALKING





JOGGING





Please indicate any physical conditions or restrictions you have:
 

Respiratory
Joint problems
Back problems
High blood sugar
Low blood sugar
Seizures

 
Please indicate if you have adverse reactions to any of the following:
  High altitude
High temperatures
Low temperatures		  
EQUIPMENT
Please indicate the equipment you plan to rent. This information will allow us to get a basic count. Changes may be made later
  Tent ($12/wk)
Backpack ($16/wk)
Sleeping Bag ($18/wk)
Sleeping pad [not an air mattress] ($3/wk)
REGISTRATION FEE
How would you like to pay your registration fee?


Credit Card
Check