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Name:
Address:
City/State/Zip:
Phone: Fax:
E-mail address: T-shirt Size:

Your history and experience:
Height: Weight: Age:

Any Injuries?

First aid or CPR experience:

Climbing Experience: Novice Intermediate Advanced Expert
Personal Reference:
Their Phone Number:

Disclaimer:
Anyone participating in this expedition does so at his or her own risk. Serious injury or death may occur as a result of your participation. Journey to the Center of the Earth is designed for experienced individuals who can evaluate their own risk. By completing this form you are accepting these risks whether they are obvious or hidden. (Note: Before joining the trip you will be required to sign a release of liability waiver.)


If you have problems submitting the form you can also print it out and send it to:
Adventure Quest
306 Walnut St.
Pacific Grove, CA 93950
Fax: 831-643-2620

 

 

 

 
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