MITOC Circus Signup Form

CONTACT INFO:

Name
Email
Phone
Emergency Contact Phone

TRIP CHOICE:

Choose the trip you'd like to go on (either costs $35):

IOCA trip: hiking, canoeing, camping, climbing, other revelry; Apr 18-19 (led by Pat Brown)
Sea Kayaking, Cape Cod, Apr 18-21 (very limited space; led by Rick Abbot, Steve Linder, and Cathy Lavelle)

TRANSPORTATION:

I have a car I'm willing to drive. It holds people including the driver.
I'm 25 or older and I'm willing & able to drive a van rented by MITOC.
I need a ride. Will you please find me one?

Note that if you drive, you will be reimbursed for gas. Transportation arrangements will be dealt with separately for each trip; contact the trip leaders for more info.

MEDICAL:

Please list allergies or medical conditions you have:

Do you have medical training? No
Yes --  what level? 

Form created and maintained by Greg Galperin, grg@ai.mit.edu