AND
MOUNTAINEERING CLUB INC.
SNOWCRAFT COURSES 2011 - REGISTRATION FORM
Please circle the course(s) you wish
to be on.
SC 1 Basic SC 2 Intermediate SC 3 Advanced
30 or 31 July 13 or 14 August 27 or 28 August
Briefings Wed 27th July Wed 10th August Wed 24th August
Costs are in Newsletter (or on the
Courses web page). Course fees (for any
or all of the course series) are to accompany the completed registration form
and be received by the Snowcraft organiser (Terry
Crippen) by Thursday 14th July.
Refunds will be made for curtailing the course due to weather conditions
or otherwise at the discretion of the course directors. Refunds for cancellations after the Thursday
14th July deadline will receive a 50% penalty. Cheques payable to Palmerston North Tramping & Mountaineering Club.
(PNTMC)
Receipts are not normally issued -
do you require one? Yes / No
Name:
…………………………………………………………………………………………………………………………….…………..
Age: ………………………. Boot size (for
crampon hire) …………………………………………………….
Address:
………………………………………………………………………………………………………………………….
Phone: ……………………………………………. (home) ………………………………………… (work)
Email: …………………………………………….
Do you have: Ice axe -
Yes/No? Crampons - Yes/No?
Do you suffer from (please tick)
Asthma … Migraine … Diabetes … Allergies …
Anything else
likely to cause a problem?
……………………………………………………………………….
Do you take special medication? Yes
/ No
If so please bring enough for the duration of the course and extra
should you be delayed. Discuss
medication needs with the course director.
We cannot be held liable or responsible for any person failing to
disclose relevant information about their current medical condition.
Name: ……………………………………………………………..
Phone ………………………………………………….
Address:
………………………………………………………………………………………………………………………….
Previous Experience: Please give us
an indication of your snow skills and outdoors experience.
Please note that each weekend course
is a pre-requisite for the next (unless matched by previous equivalent
experience).
…………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………
Closure date for Applications is Thursday 14th July:
On receipt of your registration and
course fees you will be sent further information as appropriate.
Further information
- contact the Course Organisers:
Bruce van Brunt (06)328-4761, Terry Crippen 027 6433-637.
How did you find out about the
course? …………………………………………………………………………
General Disclaimer:
I the applicant recognise that the instructors have responsibility for managing
the safety of all the course activities I will take part in. I understand that all activities are
voluntary and acknowledge that if I choose to act outside directions given by
an instructor then I accept responsibility for my own safety. I agree to abide by the conditions for
attendance at the above course; or my child/charge will attend the course on
these conditions.
Signature:
……………………………………………………………………… Date ………………………………………
If you are under 18 years old we require the signature of a parent or
guardian as well.