Trip: _________________________________ Trip Dates:________________________
Name as it shall appear on your ticket: _________________________________________
Address: _______________________________________________________________
City and State: ___________________________________________Zip: ____________
Home phone: __________________________ Cell: _____________________________
Work number: _____________________ E-mail________________________________
Prefers to room with and has checked with: ______________________________________
Male: ____ Female: ____ Smoker: ____ Non-Smoker: ____
In Case of Emergency please contact:
Name: _____________________________________ Phone: ______________________
Relationship: ____________________________________________________________
Other emergency information: _______________________________________________
Oak Park Ski Club Trip Policy
I acknowledge that I have read and agreed to the above policy.
Signed: ______________________________________Date:______________________
Payment: $ ______________Check # ___________ Date: ___________________ Initials ____________