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Basic Mountaineering Course. Outer Element Adventures. -Registration Form-. Thank you for your interest in Outer Element Adventure's Basis Mountaineering ...
Basic Mountaineering Course Outer Element Adventures -Registration FormThank you for your interest in Outer Element Adventure’s Basis Mountaineering Course. In this course you will learn the basic skills needed to climb safely with a group in an alpine mountaineering environment, where travel may involve traversing glaciers or negotiation of steep slopes of rock and snow. The course consists of six total trainings, three classroom and three field sessions all to be held at a to-bedetermined (TBD) location. Lecture sessions are on Thursdays from 7-9 pm and field sessions are held on Saturdays from 8am-4pm. Each lecture and field session must be attended and fully completed to gain the adequate knowledge necessary for basic mountaineering. Upon completion of this course, the undersigned participant will be awarded Basic Mountaineering Skills Certificate from Outer Element Adventures. Registration cost: $225.00 (re-certification) $425.00 (new participants) Registration Information Last name

First name

Date of birth

Male/Female

Phone

Email address

Address

City

State and Zip

Parents information (if participant age is under 18) Parent's/Guardian’s name Phone number

Relationship to participant

Place of work

Email address

Participant medications (if applicable)

Primary phone number

Secondary phone number

Primary phone number

Secondary phone number

Emergency Contact 1 Name Emergency Contact 2 Name

Previous mountaineering training and/or experience (circle) Please indicate physical condition (circle) Any previous or existing medical issues or medications?

Name

Signature

Basic 0-2 years 2+ years None Athletic Good Average Poor Yes No

Date

Upon your signature above, you are requesting registration for a basic level mountaineering course provided by Outer Element Adventures. You agree to pay the full amount due (plus tax) upon registration. Further you understand that the FULL amount is non-refundable unless extenuating circumstances are present, such as accident, decline in health, or family emergency. If extenuating circumstances are present, a to be determined amount will be refunded at the discretion of Outer Element Adventures. Outer Element Adventures shall have no obligation to provide services to above signee until the non-refundable amount is paid in full.