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Section 1 of 4
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Email address*
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I commit to going on the trip for the dates listed above
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I need more information. Please have a club representative contact me. <you must fill out required fields on form and "Submit">
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Tripper Type
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Member - I am a Member of the Miramar Ski Club
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Guest 1 - I am new to Miramar Ski Club and have never been on a trip with the club before
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Guest 2 - This will be my second trip as a guest of Miramar Ski Club
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Guest 3 - This will be my third trip as a guest of Miramar Ski Club
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Guest 4+ - This may be my fourth or more trip as a guest of Miramar Ski Club
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Leader - I am the Trip Leader on this trip
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Staff - I am the Staff on this trip
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SIT - I am Staff in Training on this trip
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Child age 3 to 6 -
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Child age 7 to 17 -
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Young Adult age 18 to 25 - Full time student supported by member parents
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First Name
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Last Name
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Gender
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Male
Female
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E-Mail Address
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Daytime Phone
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Evening Phone
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Mobile/Cell Phone
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Name of Emergency Contact Person
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Phone number(s) of Emergency Contact Person
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Transportation
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I am driving
I've arranged for a ride
Need a ride both ways and can relief drive
Need a ride both ways
Need a ride to Vermont only and can relief drive
Need a ride to Vermont only
Need a ride back home only and can relief drive
Need a ride back home only
On bus-plane-train and renting car locally
On bus-plane-train need local ride
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Number of riders I can take
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5
6
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Departure Date, Time, and Location
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Return Date, Time
*
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Preferred Activities
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Hiking
Biking
Running
Swimming
Canoeing - Rowing - Kayaking
Shopping
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Meal Preference
*
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Non-Red Meat
Vegetarian
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If there are other persons coming with you enter names here
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Name(s) of person(s) going on trip I prefer to room with in the lodge
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Do you snore?
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Yes
No
Occasionally
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Section 2 of 4
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How many off trip nights will you stay?
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1
2
3
4
5
6
Other…
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Membership Type
*
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Regular
Associate
Golden
Limited
Platinum
Dues Due - I am a Member - but my dues are not paid up to date
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Special Consideration / Priority
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1 Member already staying in lodge on vacation
2a Bumped from previous trip
2b Executive Committee & Board of Trustees
2c Winter and Summer Trip Committee
2d Outstanding Service Group
2e Attended Work Weekend this calendar year
2f Category 1 or 2 but made a late cancellation in the previous 2 weeks
2g Member reserving by cutoff date/time & was in dorm on last trip
3 Member reserving by cutoff date/time
4 Member reserving after cutoff date/time
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Preferred Room
*
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A
B
C
D
E
F (driver)
G
H
I
J
K
L
M
N
O
P
Q
R
S
Hilltop
Riverview
Quiet Room
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Section 3 of 4
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If you are new to Miramar Ski Club how did you find out about us?
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Internet search
Miramar Website
Facebook
Twitter
Meetup
A friend
A family member
Word of mouth
Print ad
Flyer
Brochure
Ski/Snowboard Show
Appalachian Mountain Club
The Metropolitan New York Ski Council
The New Jersey Ski & Snowboard Council
Newspaper Article
TV or Radio
Other…
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Section 4 of 4
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Comments
*
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I commit to going on the trip for the dates listed above
 
 
 
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Tripper Type
 
 
 
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First Name
 
 
 
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Last Name
 
 
 
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Gender
 
 
 
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E-Mail Address
 
 
 
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Daytime Phone