Alaska Guide Collective Trip Registration
Please fill out one form per guest.
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Email *
Trip start date *
Add the correct Month, Day and YEAR trip starts in
MM
/
DD
/
YYYY
Your guide name *
Required
Trip name *
The last name of your groups organizer
Your First name *
Your Last name *
Preferred name
Street address *
City *
State *
Country *
Zip Code *
Phone number *
Occupation
Outdoor experience related to this trip *
Summarize your exercise schedule and fitness level *
MEDICAL INFORMATION
Your medical information provided is held private, completely confidential. Please be honest and complete with your answers. Your information does not inhibit the participation on trips. For the remote nature and often strenuous activity on trips it is important that we have full details of any medical conditions, past injuries or prescription drugs used. Your information is held professionally by AGC and your guide.
Gender *
Age *
Height *
Weight *
Do you have asthma? If so, please explain. *
Do you have diabetes? If so, please explain. *
Do you have allergies? If so, please explain. *
Do you have heart disease? If so, please explain. *
Do you have seizures? If so, please explain. *
Have you had altitude illness? If so, please explain. *
Are you taking any medications? If so, please list. *
Any other medical or physical conditions that may affect your ability to participate in this trip? *
I assure that all the above medical information is accurate. *
EMERGENCY CONTACT INFO
Someone close to you that is Not on your trip
Emergency contact name *
Emergency contact relation *
Emergency contact phone number *
Emergency contact secondary phone
Emergency contact email *
Rescue and trip insurance *
Details in Reservation and Cancellation Policy
Required
I understand I am responsible for my own transportation. *
AGC representatives do not provide transportation service.
Photo release *
Do you grant AGC the use of photos taken of you during the trip for website, marketing or other purposes?
SKI TRIP QUESTIONS
Mode of travel for ski or snowboard trips
Ski or snowboard skill level
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