WINTER TRIP REGISTRATION
Please print this form and mail to the above address. This Form and payment must be mailed in with request and received by the Reservations Office at least two (2) weeks prior to departure.
Personal checks will not be accepted. Only credit card (VISA or Master Card), bank check, or money order will be accepted for winter reservations.
Trip Dates:
Number in Party:
Please specify (X) type of site desired: __ Lean-to, __ Cabin, __ Tent, or __ Bunkhouse
Destination, Proposed Itinerary, and Routes:
WINTER CAMPING PARTY NAMES
LEADER'S NAME:________________________________________
CO-LEADER #1:__________________________________________
CO-LEADER #2:__________________________________________
TEAM MEMBER:_________________________________________
TEAM MEMBER:_________________________________________
TEAM MEMBER:_________________________________________
TEAM MEMBER:_________________________________________
TEAM MEMBER:_________________________________________
TEAM MEMBER:_________________________________________
TEAM MEMBER:_________________________________________
MOTOR VEHICLE INFORMATION (FOR VEHICLES PARKED AT
PARKING LOT):
MAKE/COLOR/PLATE #:__________________________________
Type of payment: Bank Check 0r Money Order#_______________
(Personal Checks not accepted)
VISA or MASTER CARD #___________________________ expiration date:____________
LEADER INFORMATION
Name:
Mailing Address:
Home Phone:
Work Phone:
Prior winter experience in Baxter State Park ? IN OTHER WILDERNESS AREAS?
Emergency notification
Name:
Relationship:
Address:
Home Phone:
Work Phone:
I ATTEST THAT TO THE BEST OF MY KNOWLEDGE, ALL MEMBERS ARE CAPABLE AND FIT ENOUGH TO ENSURE OUR SAFE COMPLETION OF OUR PROPOSED ITINERARY.
___________________________
Leader's Signature
ASSISTANT-LEADER INFORMATION
Name:
Mailing Address:
Home Phone:
Work Phone:
PRIOR WINTER EXPERIENCE IN BAXTER STATE PARK? IN OTHER WILDERNESS AREAS?
Emergency notification
Name:
Relationship:
Address:
Home Phone:
Work Phone.
ASSISTANT-LEADER INFORMATION
Name:
Mailing Address:
Home Phone:
Work Phone:
PRIOR WINTER EXPERIENCE IN BAXTER STATE PARK? IN OTHER WILDERNESS AREAS?
Emergency notification
Name:
Relationship:
Address:
Home Phone:
Work Phone.
TEAM MEMBER INFORMATION
Name:
Mailing Address:
Home Phone:
Work Phone:
Emergency Notification
Name:
Relationship:
Address:
Home Phone:
Work Phone:
TEAM MEMBER INFORMATION
Name:
Mailing Address:
Home Phone:
Work Phone:
Emergency Notification
Name:
Relationship:
Address:
Home Phone:
Work Phone:
Name:
Mailing Address:
Home Phone:
Work Phone:
Emergency Notification
Name:
Relationship:
Address:
Home Phone:
Work Phone: