Join

Today's Date

Name

Age

Date of Birth

Address

City / State

Phone (Home/Work/Cell)

Email Address

Climbing Courses - Basic | Intermediate | Advanced | Other (List name of club or school, and dates)

Climbing Experience - Rock | Snow & Glacier | Winter Climbs | Expeditions (List peak, location, route, date)

Medical Training - Level of training (Basic First Aid, Advanced First Aid, EMT) & Expiration Date

Other Relevant Training and Experience (Radio, wilderness, survival, clubs, other Search & Rescue, et.)

Equipment: Please check equipment that you own. Equipment: Please check equipment that you own. Crampons Helmet Ice axe Ice screws Ice hammer Snowshoes Snow shovel Headlamp Flukes Pickets Down/Fiberfill parka Down/Fiberfill mitts Down/Fiberfill sleeping bag Rock hardware rack (chocks, stoppers, etc.) Rescue pulleys Ascenders Stove Tent Skis Climbing rope

Other equipment not specified

Any other notes you would like to include