IOCA/MITOC Fall Lake George '99 Signup Form for MITOC Members

NOTE: we are almost to capacity, if you are number 32 or greater it will be unlikely that we'll be able to accomodate you unless you are your personal canoe or watercraft. if you do contact hbriceno@mit.edu directly.

CONTACT INFO:

Name
Email
Phone
Emergency Contact Phone
Medical Insurance Company
Medical Insurance Policy No.

TRIP INFO:

Dietary Restrictions

TRANSPORTATION:

I have a car I'm willing to drive. It holds people including the driver,
       canoes and bicycles.
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, each passange will give you $10-15 for gas and tolls.

MEDICAL:

Please list allergies or medical conditions you have:

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

Form created Greg Galperin. If you have problems, contact hbriceno@mit.edu