AMC New York-North Jersey Chapter

Pre-Registration Form

Copyright © 1996 - 2017 Appalachian Mountain Club, Boston, MA.

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Enter your registration information:

  Please fill in the information requested below and press the [Pre-Register] button to submit your application for this event.
  Your name: First & last names are required.
First:   Middle or Ini:   Last:
 
  Your e-mail address: Only one e-mail address, please.
 
  Your USPS-mail address:
Street:   City:   State:   Zip:
  Your Telephone numbers: (Include Area Code, format=9999999999)
Home:   Work:   Cell:  
 
  Submit a SEPARATE Pre-registration for each person (i.e. self, spouse, child, companion, etc.) for whom you are the contact person.
 
  Name of INDIVIDUAL person to register: Overwrite "Self" with name for others. Do NOT put more than one name here.
  Age Group:   AMC Membership status:  
 
  Additional information: (required for canoeing and kayaking events)
  Explain Other:
  Explain Other:
(If requesting a kayak, provide Height & Weight ===> )
 
 
 
 
  Relevant Experience: (Recent AMC & non-AMC trips and leaders.)
 
  Transportation status: (Need ride, have car, offer rides, etc.)
 
  Car Information: License Tag, State, Make, Model, Color: (Needed for campgrounds and parking areas)
 
  Medical Conditions: (Do you have any medical condition(s) that we should know about?)
(This includes, but is not limited to: allergies, medications, disabilities, or conditions like Diabetes or Epilepsy that may affect your performance.)
 
  Emergency Contact: (Provide name and address, phone or e-mail)
 
  Other comments, offers or suggestions:
 
Do you wish to save these form settings for next time?  
  Match this to proceed (case-sensitive)... captcha code

Press to send your event Pre-registration to the Registrar.
Press to clear the form and start over.
Click here to return.
Submitting this application does not constitute your acceptance as a participant in this activity. The leader/registrar will notify you of your status, probably by e-mail, as soon as possible.
If you have additional questions about this activity, e-mail your questions to the Registrar at: