Team Name*:

Affiliation: (School/Hospital/Organization)
Hometown: (City, State/Providence)

Team Captain

First Name*: Last Name*:
Occupation: (Physician/EMT/WFR/Student/etc.)
Email*:

Street Address*:
City*: State/Province*: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Not Applicable
Country*: U.S.A. Canada Other (enter below) If other, Country:
Zipcode*:
Phone Number:

Captain Gear Rental*
Skis OR Snowshoes ($22.50 CAD for either with exchange between allowed. However, it is possible that they will run out of your size.)
Skis AND Showshoes ($36 CAD)
None
If renting: Height: Weight: Ski Boot Size:

Vegetarian Option?*
Omnivore
Vegetarian
(*We will attempt to accommodate, but consider bringing back-up.)

Team Member 2

First Name*: Last Name*:
Occupation: (Physician/EMT/WFR/Student/etc.)
Email*:

Team Member 2 Gear Rental*
Skis OR Snowshoes ($22.50CAD for either with exchange between allowed. However, it is possible that they will run out of your size)
Skis AND Showshoes ($36 CAD)
None
If renting: Height: Weight: Ski Boot Size:

Vegetarian Option?*
Omnivore
Vegetarian
(*We will attempt to accommodate, but consider bringing back-up.)

Team Member 3

First Name*: Last Name*:
Occupation: (Physician/EMT/WFR/Student/etc.)
Email*:

Team Member 3 Gear Rental*
Skis OR Snowshoes ($22.50 CAD for either with exchange between allowed. However, it is possible that they will run out of your size.)
Skis AND Showshoes ($36 CAD)
None
If renting: Height: Weight: Ski Boot Size:

Team Member 3 Special Food Needs*
Omnivore
Vegetarian
(*We will attempt to accommodate, but consider bringing back-up.)

Questions/Comments