AND
MOUNTAINEERING CLUB INC.
SNOWCRAFT COURSES 2009 - REGISTRATION FORM
Please circle the course(s) you wish to be on.
SC 1 Basic SC 2 Intermediate SC 3 Advanced
1-2 August 15-16 August 29-30 August
Briefings Tues 28th July Tues 11th August Tues 25th 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 16th
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 16th 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 16th July:
On receipt of your registration and course fees you
will be sent further information as appropriate.
Further information - contact
the Course Organisers:
Terry Crippen 356-3588, Bruce van Brunt 328-4761.
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.