| Mountain Madness Climbing School
Registration Form |
|
| Instructions: | Mail the completed form along with a check, money order or credit card information. Our mailing address is:
Mountain Madness
|
| Or Fax to (512) 532-6685 |
|
| Class: | ________________________________________________ |
| Class Date: | _______________________ |
| Name(s): |
________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________
________________________________________________ |
| Address: |
________________________________________________
________________________________________________ |
| Email Address: | ________________________________________________ |
| Telephone: |
Home: __________________ Work: __________________ |
| ______ | I will be camping in a Mountain Madness site.
Number of campers: ________ |
| ______ | I have my own technical rock climbing shoes. |
| ______ | I will need climbing shoes from Mountain Madness.
(Technical rock boots are required to climb in this class.)
Athletic shoe size: Men's _______ Women's _______ |
| $_________ | Course Fee ( _____ # of students @ $ ______ each) |
| $_________ | Camping: Please add $5 per camper. (Camping fee is separate from park fees.) |
| $_________ | Total amount enclosed |
| Payment by: |
___ Check Enclosed (or) ___Visa ___MasterCard ___Discover |
| Card #: |
______________________________ Exp. date: ____/____ |
| Name as it appears on card: |
________________________________________________ |
| Billing Address: | ________________________________________________ |
| Billing City: | ________________________________________________ |
| Billing State: |
________ Postal Code: _______________ |
| Signature: | ________________________________________________ |
|
If you have a medical or physical condition that may require attention during the course of the weekend,
please tell us about it here. Please be specific. |
|
|
_________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ |
|