Team Name*:

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

Team GPS unit (rental included in registration)
Please reserve a GPS unit for us
We will bring a personal one

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:

Snowshoes (rental included in registration)
Please reserve snowshoes for me
I will bring my own

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*:

Snowshoes (rental included in registration)
Please reserve snowshoes for me
I will bring my own

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*:

Snowshoes (rental included in registration)
Please reserve snowshoes for me
I will bring my own

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

Questions/Comments