REGISTRATION FORM

WILD WOMEN MOUNTAIN TRIP

Name

First Name

Last Name

Email

Phone

(###)

###

####

Why are you choosing to participate in the Wild Women Mountain trip?

What is your experience with wilderness living and backpacking?

Please provide relevant health information here

Ie. medical concerns, allergies/sensitivities, behaviour, medications, speech or language, vision/hearing impairments

Do you have any fears or apprehensions about the trip?

Is there anything else you would like us to know?

How did you hear about us?

August 9th - 17th

Please fill out the form below. Once we receive it, we will send you more information about payment and the trip