______

Office Use Only- Do Not Write Above Line

ADIRONDACK FORTY-SIXERS - Questionnaire & List of Mountains

***Directions***

Follow Directions Closely. Incorrectly completed forms will be returned to the climber.

1) Use these official forms ONLY 2) DO NOT write on back of forms 3) Print Clearly 4) Use BLACK INK ONLY

Mail Completed Forms to:

Adirondack Forty-Sixers, Office of the Historian, P.O. Box 46, Fort Edward, NY 12828.

Each Climber Should Mail $8 Initial Dues to the Treasurer:

Adirondack Forty-Sixers, Treasurer, P.O. Box 180, Cadyville, NY 12918

NAME:

As you wish it to appear on your Certificate of Accomplishment

ADDRESS:

CITY: ______STATE / PROVINCE: ______ZIP: ______COUNTRY: ______

(Abbreviation) (If other than USA)

E-mail Address: ______Phone Number (______) ______-______

Your Age: ______Male: ______Female: ______Occupation:

First 4,000-ft. Adirondack Peak climbed by you: ______Date:

(Month/Day/Year)

46th / last 4,000-ft. Adirondack Peak climbed by you:

Date: ______EXACT arrival time on summit:

(Month/Day/Year)

How did you come to climb the 46? Describe any of your favorite/ least favorite memories/moments while climbing the 46. These may be quoted in the 46ers Peeks magazine and website. If you don’t have enough space please include a one page letter along with the official paperwork:

ADIRONDACK FORTY-SIXERS - OFFICIAL LIST OF MOUNTAINS

Elevations listed are from the most recent USGS survey. While four of the peaks are under the original 4000-or-more-mark, you must climb them to become an Adirondack Forty-Sixer.

Submission of completed Questionnaire and Official List of Mountains are required to become a Recorded Forty-Sixer.

Climber Name: ______

MOUNTAIN / ELEVATION
FEET / DATE / MOUNTAIN / ELEVATION
FEET / DATE
Algonquin / 5114 / Iroquois / 4840
Allen / 4340 / Lower Wolf Jaw / 4175
Armstrong / 4400 / Macomb / 4405
Basin / 4827 / Marcy / 5344
Big Slide / 4240 / Marshall / 4360
Blake Peak / 3960 / Nippletop / 4620
Carson Peak (South Dix) / 4060 / Nye / 3895
Cascade / 4098 / Panther / 4442
Cliff / 3960 / Phelps / 4161
Colden / 4714 / Porter / 4059
Colvin / 4057 / Redfield / 4606
Couchsachraga / 3820 / Rocky Peak Ridge / 4420
Dial / 4040 / Saddleback / 4515
Dix / 4857 / Santanoni / 4607
Donaldson / 4140 / Sawteeth / 4100
Emmons / 4040 / Seward / 4361
Esther / 4240 / Seymour / 4120
Giant of The Valley / 4627 / Skylight / 4926
Gothics / 4736 / Street / 4166
Grace Peak (East Dix) / 4012 / Table Top / 4427
Gray Peak / 4840 / Upper Wolf Jaw / 4185
Haystack / 4960 / Whiteface / 4867
Hough / 4400 / Wright / 4580

Preference of peaks and why:

1.  ______

2.  ______

3.  ______

Peak(s) least enjoyed and why: ______

______

Did you become a new 46er alongside any family member(s) or friend(s)? NO _____ YES ______

Name(s) of family member(s) or friend(s) who finished at the same time as you: ______

Now that you have finished the 46 please consider participating in the club's volunteer projects (listed on the 46er website) to give something back to the mountains.

[Revised Nov. 2015]