| ........RESERVATION FORM PLEASE COMPLETE: |
......First Name:
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......Last Name:
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......E-Mail:
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......Address:
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......City:
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State:
Zip Code:
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Country:
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......Home Phone Number:
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......Work Phone Number:
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......Cell Phone Number:
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Course #1 (Rock Climbing Courses only):
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Desired Date(s):
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.Course #2 (Includes Workshops, Adventure Courses, Backpacking, Kayaking, Hiking & Climbing Trips):
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Desired Date(s):
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.In case of emergency, please
notify (name/phone number):
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Do you have any medical
conditions?
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Are you allergic to bee stings?
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What is your level of fitness?
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Sex:
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Do you need rock climbing shoes (you can't climb in hiking boots and they're no charge)?
If so, what is your shoe size (American sizes only We don't have sizes above 13)?
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Do you need a climbing harness (no charge)?
If so, what is your waist size?
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Do you need a daypack ($5 charge per day)?
Are you bringing a friend for the $15 discount?
Do you have an REI Membership?
If so, what is the Membership No. (to receive discount)?
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Previous rock climbing experience? What are your expectations? Questions?:
If this is a gift certificate, fill out the box below with any additional information on who you are purchasing it for.
Also let us know how you would like us to send the gift certificate.
A gift certificate may be purchased for any of our courses or in amounts of $25, $50, $75 or more.
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...............How did you hear about us?
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...............Birthdate:
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...............Place of birth:
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| CREDIT CARD PAYMENT |
| If you leave the following credit card fields blank, please call to complete the transaction over the phone (within 24 hours of sending this form), or send us your credit card information by mail, email or fax. |
Credit Card Type:
...
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Credit Card Number:
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Card Expiration Date: ........Total Amount (with discounts) $
Enter month/year. For example, January 2008 is entered 01/08
Enclose full registration course fee (Visa®, MasterCard®, checks or money orders made out to the Arizona Climbing and Adventure School) with your application to: ACAS, P.O. Box 3094, Carefree, AZ 85377. A 30-day (prior to course starting date) cancellation notice is required to receive course rescheduling or refund (postponed by us due to weather or other circumstances - alternate dates or refunds will be given as preferred by us). You agree to these terms by emailing this form.
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