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Phone: Fax:
E-mail address: T-shirt Size:

Your history and experience:
Height: Weight: Age:
Number of Basejumps: Time in the Sport:
Building Antennas Bridges Cliffs Other
Any Injuries?
Lowest BASE jump: Pro rating? First aid or CPR experience:
Accuracy Level: Novice Intermediate Advanced Expert

BASE Equipment you plan to use:
Container: Main:
Reserve: Gear Manufacturer:

Skydiving Experience: Time in the Sport:

Drop Zone You Frequent:
DZ Phone Number(s):

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. BASE Jump Kjerag 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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