CGI Registration Form

Please fill out the following form:

Name *

First

Last

Street Address *

City *

State *

Zip Code *

Phone *

Email *

Date of Birth (mm/dd/yyyy) *

Emergency Contact Name *

Emergency Contact's Phone Number *

Do you have any medical conditions I should be aware of? If you prefer you can tell me in person before we climb. *

If so, please explain.

Do you have any dietary restrictions? (For overnight courses only)

If so, please explain.

Course type *

Course start date (mm/dd/yyyy) *

Need Climbing Shoes or Boots? *

If so, shoe size?