| Registration
for Glacier Snowboard Camp |
|
| *Please
completely fill in registration form. Please print. Circle selections
where needed! |
|
| Name
of Athlete: |
____________________________ |
| Name
of Parent (if minor): |
____________________________ |
| Sex: |
male female |
| Level
of Expertise: |
novice Intermediate expert |
| Address: |
____________________________ |
| ____________________________ | |
| ____________________________ | |
| Province/State: |
____________________________ |
| Country: |
____________________________ |
| Postal
Code/Zip Code: |
____________________________ |
| Phone: |
____________________________ |
| Fax: |
____________________________ |
| E-Mail: |
____________________________ |
| Health
Insurance Co.: |
____________________________ |
| Health
Insurance #: |
____________________________ |
| Birth
Date: |
mm/dd/yyyy___________________ |
| Would
Like To Room With: |
____________________________ |
| Would
you like a round trip from vancouver airport?(can$60): |
yes no |
| |
|
| Session
#1, Adult Camp 8 Day / Jun 25 - July 2 2010 |
With Accommodation With Out Accommodation |
Session
#1 Standard Camp 6 Day / Jun 25 - July 2 2010: |
With Accommodation With Out Accommodation |
| Session
#2 Standard Camp July 2 - July 9 2010: |
With Accommodation With Out Accommodation |
| |
|
| Payment
Information |
|
| Payment
Type: Checquing Information: |
Credit Card Cheque Send $300 Deposit to Glacier Snowboard Camp #219-2222 Castle Dr. Whistler, BC V0N 1B2 |
| Credit
Card Type: |
Visa |
| Name
on Credit Card: |
________________________________________________________ |
| Credit
Card Number: |
________________________________________________________ |
| Credit
Card Expiry |
________________________________________________________ |
| |
|
| How
Would You Like To Be Contacted? |
Email Postal |
| Additional
Comments: |
________________________________________________________ |
| ________________________________________________________ | |
| ________________________________________________________ | |
| ________________________________________________________ | |
| ________________________________________________________ | |
| Date: |
2/8/2012 |
| Athlete
Signature: |
____________________________ |
| Parent
Signature (if minor): |
____________________________ |