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Av1 2024 Registration Form
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* Indicates required question
Personal Information
First Name
*
Your answer
Middle Initial
Your answer
Last Name
*
Your answer
Gender
*
Male
Female
Genderqueer/Non-binary
Prefer not to disclose
Age
*
Your answer
Address and Contact Details
Email
*
Your answer
Day Phone
*
Your answer
Evening Phone
Your answer
Address1
*
Your answer
Address2
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
Emergency Contact
Emergency Contact Name
*
Your answer
Emergency Contact Day Phone
*
Your answer
Emergency Contact Evening Phone
*
Your answer
Additional Information
What is your organizational affiliation?
*
Example: NSP/Pinecrest Nordic, SAR/Tuolumne County
Your answer
NSP Member ID
NSP Members only need to answer this.
Your answer
NSP Patroller Status
Choose
N/A
Candidate
Patroller
Auxillary
Please describe any relevant avalanche training you have had.
*
Your answer
What, if any, types of avalanche terrain have you encounted?
*
Your answer
What, if any avalanche equipment do you own. (Specify make/model of beacon)
*
Your answer
What type of snow transport do you intend to use (snowshoes, telemark, AT).?
*
Your answer
Waiver
*
You will be required to sign a waiver before participating in this course. For a preview of the complete waiver see:
http://www.pinecrestnordic.org/files/education/mtr1/Far_West_Division_release_Avy_and_MTR.pdf
I'm cool with that (this is not an acceptance of the waiver)
I am over 18
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