AMC Adventure Travel #2031: "Trekking Patagonia: Chile and Argentina" -- Online Registration Form

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Thank you for your interest in the “AMC Trip #2031: "Trekking Patagonia: Chile and Argentina” from Saturday, February 15, 2020 to Saturday, February 29, 2020. (https://activities.outdoors.org/search/index.cfm/action/details/id/112169)

Please read the trip's Prospectus at https://adventuretravel.outdoors.org/2020/2031.pdf to ensure our group has comparable abilities and expectations.

After reading the prospectus if you are still interested to register for this trip, please fill out this Online Registration Form below and submit online.

Please send this Reference link, https://forms.gle/HyopEkkMRcHRSjLZA, to three references who can vouch for your hiking activity, abilities, and experience with group travel. If you are an active outdoors person with limited hiking references, please feel free to contact Leaders to discuss trip details.

In addition to completing the online registration below, please also download, print, fill out, sign and date the following documents that are also included in the prospectus or from the links below. We will need both the online copy of your application as well as a hard copy with your official signature. Thank you for your cooperation.

1. AMC Trip #2031 Patagonia Application Form:
  https://drive.google.com/open?id=1VDsKzMJjdRE_adJpbmW-V4h1D5yYikEu (pdf)

2. AMC Assumption of Risk Participant Release Form:
 https://drive.google.com/open?id=1tz3DbvOpG6KCC1Su1Thg2lYRZrBgZEH_

3. AMC Medical Form:
https://drive.google.com/open?id=14xLxlzLIaVEff7sAags-hhw1qXVIjGyp

4. AMC Supplemental Medical Form  (Optional):
https://drive.google.com/open?id=1qRytMtTdI5GPZvHfKV48N3Jao8Q0Za-2

Mail the above ink-signed forms along with a deposit check for $1,000 payable to the "Appalachian Mountain Club" to:

Joan Chambers
PO Box 2532
Woburn, MA 01888

Your check will not be deposited unless we offer you a place. If you are accepted from a waiting list, we will not deposit your check unless you confirm that you are still interested.

We expect this trip to fill quickly so the sooner you can get everything in the better and the sooner we can start the screening process. If you have any questions or concerns, please contact Leaders Joan and Cliff Chambers at wu.chambers@gmail.com or 617-680-3735.

Please remember that all AMC Adventure Travel events are led by volunteers. As such, they may be unable to respond to your inquiry immediately. However, they are very dedicated and will contact you as soon as possible.

Please read and understand the cancellation policy in the trip prospectus before sending any money.

Please be sure to click "SUBMIT" button at the very bottom of this form to complete the submission.

Email *

FName *

First Name as shown on your Passport

LName *

Last Name as shown on your Passport

MName

Middle Name as shown on your Passport

Name *

Nick Name (how would you like to be called)

Gender *

Required

DOB *

Date of Birth as shown on your Passport

YYYY

Height/Weight *

(e.g., 5'8"/160 lbs)

Address *

Home Address (Street, City/Town, State, Zip Code, Country). AMC trips are run on a non-profit basis and refund of unspent funds after the trip will be mailed to you. If you have a change of this address, please let the leaders know.

Phone (C)

Cellular Phone # (e.g., 617-680-3735)

Phone (H)

Home Phone #

Roommate

Name of your travel companion(s) on this trip, if any.

Airport(s)

Preferred Home Airport Codes (e.g., BOS, JFK, etc.)

Allergies? *

Any Allergies or Diet Restrictions? If none, please specify "None".

Emergency Contact #1 *

Emergency Contact #1 (Name, Phone #, Address, Relationship)

Emergency Contact #2 *

Emergency Contact #2 (Name, Phone #, Address, Relationship)

Three Hiking References:

Please list at least three references, preferably AT Trip Leaders if you have been on previous AT trips and something about how you know this person (List someone who can vouch for your activity, abilities, and experience with group travel).

If you are an active outdoors person with limited hiking references, please feel free to contact Cliff Chambers at (617) 680-3735 to discuss trip details. Please leave a voicemail if no answer.

Reference #1 *

Name, Email and Phone # of Trip Leader(s), Trip Dates, Trail Name(s), Cumulative Elevation Gain/Loss, Distance, Average Moving Speed and Total Time.

Reference #2 *

Name, Email and Phone # of Trip Leader(s), Trip Dates, Trail Name(s), Cumulative Elevation Gain/Loss, Distance, Average Moving Speed and Total Time.

Reference #3 *

Name, Email and Phone # of Trip Leader(s), Trip Dates, Trail Name(s), Cumulative Elevation Gain/Loss, Distance, Average Moving Speed and Total Time.

A copy of your responses will be emailed to the address you provided.

Submit

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