PARTNERS IN THE PARKS
GREAT BASIN
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 physical activity that you can comfortably 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 allergies or other diet restrictions.
  Lactose intolerant
Sugar restricted
Vegetarian
Vegan
Food Allergy

Describe food allergy if checked:
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)
SAFETY TRAINING
Please indicate if you are currently certified in any of the following:
  Red Cross First Aid (or equivalent)
Red Cross Life Guard (or equivalent)
Wilderness First Responder
 
REGISTRATION FEE
How would you like to pay your registration fee?


Credit Card
Check