Stateline Trail traverse w/ Here mt application

Name

First Name

Last Name

Phone

(###)

###

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Gender

Date of Birth

YYYY

Race/Ethnicity

Choose the option which fits you best.

Are you BIPOC with intersection identities?

Why are you interested in this trip?

What is your experience hiking/backpacking?

Have you volunteered with GBCA before?

Yes

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Please identify and explain any medical problems, injuries, or other situations we should be aware of that might impact your ability to participate in this trip.

Will you be carrying any medications with you on this trip?

Yes

If yes, please provide name and dosage

Please describe any allergies you have, their severity, and what you usually do for treatment.

Release of Liability