Application: Rock School 2021
Email address *
First Name *
Last Name *
Birth Date *
MM
/
DD
/
YYYY
Member Since (e.g. July, 1984) *
Street Address (e.g. 14416 Mt Rainier Court, Apt A) *
City *
State (e.g. WA) *
Zip *
Primary Phone Number (e.g. 509-978-9410) *
Primary Phone Number Type *
Secondary Phone Number (e.g. 509-978-9410)
Secondary Phone Number Type
Clear selection
Emergency Contact Name *
Emergency Contact Relationship to You *
Emergency Contact Phone Number *
Please write a paragraph or two, sharing your reasons for wanting to enroll in this school. What do you hope to gain? *
Please describe your climbing experience. *
I understand that this seminar may have a waiting list and, if accepted, am committed to attending all scheduled indoor and outdoor sessions. *
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