PARK CITY Trip Application
JANUARY 28-FEBRUARY 4, 2019

FUND & BANK STAFF SKI CLUB

Note: For a couple or family, each participant must fill out an application below.

Name (as it appears on your legal form of ID) *
Your answer
Email Address *
Your answer
Cell Phone Number *
Your answer
Status *
*Guests on this trip limited to one per accompanying IMF/WB member due to high demand
Birthday *
MM
/
DD
/
YYYY
Are you *
Singles will be paired if possible with someone of the same gender. If necessary, are you willing to room with someone of the opposite gender? *
Please provide a name of a preferred roommate. If you don't know, just leave this question blank.
Your answer
Southwest frequent flyer number
Your answer
Known Traveler Redress Number (if any)
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Park City Lift Ticket Options
Trip price adjusted accordingly, as shown. Can be combined with Deer Valley options below.
3 Day (-102.00)
4 Day (-37.00)
5 Day (included)
6 Day (+58.00)
Epic Season Pass
Park City
Deer Valley Lift Ticket Options
Trip price adjusted accordingly, as shown. Can be combined with Park City options above.
1 Day (+109.00)
2 Day (+200.00)
3 Day (+299.00)
Deer Valley
Amount paid with Application (balance due by Dec 15) *
Have you already paid your 2018/19 Club dues? *
I haven't paid, but am sending a separate check for:
I am a: *
Insurance:
The Club recommends that participants purchase sufficient travel insurance and medical insurance as it will not be liable for any injuries caused during the trip or for trip cancellations made by the participant after the cancellation deadline. You can compare and purchase travel insurance at insuremytrip.com.
Upon Pressing "Submit", your application goes directly to Trip Leader:
PLEASE MAIL CHECKS (one for membership dues and another for trip payment) to:
Chanda DeLong, 1412 Chapin St NW Apt 405, Washington DC 20009
Submit
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