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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 ^*
  • Last Name ^*
  • Cell Phone ^*
  • Home Phone ^*
  • Skier/snowboarder Type ^*
    Visually Impaired Skier Visually Impaired Boarder Guide Friend
  • Street Address ^*
  • 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 ^*
  • Gender ^*
    - please select - Male Female
  • Emergency Contact ^*
  • Emergency Phone 1 ^*
  • Emergency Phone 2
  • Emergency Contact Address

    street, city, state, zip
  • Relation ^*
    Spouse Parent Sibling Friend Other
  • Special Instructions

    list special needs
  • Official use only

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