P.O. Box 911 Valdez, AK 99686

907.255.2242

REGISTRATION INSTRUCTIONS: Please fill out all sections of this two page registration form completely. Return to AAIC by post or email with full tuition.

We look forward to your participation!

Class: AIARE Level 1 Valdez

Dates: April 3-5, 2012

Name:

Home Phone:

Cell Phone:

Email:

Date of Birth:

Mailing Address:

Gender: ○Male ○Female

Emergency Contact Information: (name, relation, & phone #)

Where will you be staying while in Valdez?

What other avalanche training do you have?

What mode of backcountry travel will you be using? (circle)

Randonnee skis tele skis split board snowshoes

How did you hear about us?

AAIC Class Reservation & Cancellation Policy

Full tuition is due at time of registration.

AAIC students must make a cancellation request more than 30 days prior to the start date of the class to receive a full refund, less a processing fee of $50. Cancellations made less than 30 days prior to the start of the class will not receive a refund unless the program is full and the spot is filled from the waitlist.

AAIC reserves the right to dismiss a participant from a class if instructors find the participant un-fit mentally or physically. AAIC does not refund class costs if a participant leaves during an AAIC class due to an injury or for personal reasons.

For a $25 fee, a student may decide to change from one AAIC class to another, or a student may decide to transfer the tuition they’ve paid over to another student.

I have read, understand, and accept the AAIC reservation and cancellation policy stated above and acknowledge that this agreement shall be effective and binding upon the parties during the entire period of participation. AAIC may use pictures taken of me in promotional materials.

______

Signature of Student Date

______

Parent or Legal Guardian for Students Under 18 Date

PAYMENT INFORMATION: (circle)

Check (Made out to Alaska Avalanche Information Center) Paypal

P.O. Box 911 Valdez, AK 99686

907.255.2242