MLK Ski Trip Registration Form

Name

This address will receive a confirmation email

Phone

Safety & Health Information

Emergency Contact Name

Emergency Contact Phone Number

Allergies we should be aware of (write "None" if not applicable)?

Medications or medical conditions we should know about (write "None" if not applicable)?

Please Check to Complete

I understand that I may either have a single bed or share a bed during the trip.

Yes

I understand that my spot is not secured until the $150 payment is completed.

Yes

PAYMENT

Payment $150

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please fill out this form to secure your spot for the MLK Ski Trip Weekend (January 16–18)!

The $150 fee covers:
- Transportation
- Breakfast
- Housing

Note:
You are responsible for paying for your own ski or snowboard rentals.
Your spot is not confirmed until the $150 payment is received.

Date:
January 16–18th

Deadline:
December 18th

MLK Ski Trip Registration Form

Description

Please Fix the Following