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• Additional Donation
  $

  In addition to the total amount shown above you may also pay an additional donation to the group. A group manager can provide you with more information about how your donation will be used. Leave blank for none.
• E-Mail Address
• • First Name ^*

    first
  • Last Name ^*

    last
  • Cell ^*

    best contact number
  • Home

    home or other
  • Skier Type ^*

    all that apply

    Visually Impaired Skier Guide Friend/ Family
  • Add Family Member Names

    add more names- w/ guide, VI,Family, etc..
  • Gender ^*

    check all that apply

    Female Male
  • Street Address ^*

    number and street name
  • Street Address 2
  • City
  • State ^*
    - please select - Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marians Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
  • Zip ^*
  • Emergency Contact Name ^*
  • Emergency Phone number ^*
  • Emergency Contact Address

    street, city, state, zip
  • Relation ^*

    emergency contacts relation to member

    Spouse Parent Sibling Friend Other
  • Special Instructions

    special needs or restrictions
  • Official use only

We accept

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