70+ Ski Breckenridge Jan 20-27, 2018 This form is to make a deposit for the 70+ Breckenridge ski trip. You will receive an invoice about 60 days before the trip requesting final payment. Please contact the club if you need the trip flyer with all the trip details or have any questions. How many people is this deposit for?12Total $0.00 Are you a club member?*Family members and friends of members are welcome to participate!YesNoName* First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country PhoneEmail* Date of Birth 2nd Person Name and Date of BirthName* First Last Date of Birth* Additional InformationPlease select room assignmentWe only share with other members.Please assign a roommateI prefer my own room and will pay single supplementPlease assign my preferred roommate (list name in comment section)Bed Preference(Subject to availability)1 bed (King or Queen)2 beds (doubles or queens)I understand cancellation policy*Cancellation policy: More than 120 days from start of trip (full refund), 60-119 days (forfeit deposit), 45-60 days (forfeit 75%), less than 45 days (no refund). Trip insurance if recommended. The club does not offer trip insurance, but it is widely available and recommendations are available on request.YesNoIs this your first 70+ trip?YesNoHow will you arrive?by Airby AutoPlease select your preferred level(s) of skiing Non-skier Easy Groomed trails (slow pace) Intermediate groomed trails (moderate pace) Intermediate & Advanced trails (moderate to fast pace) Don't even try to keep up! (moguls and glades) I agree to waiver*I understand and am aware that skiing is a HAZARDOUS activity. I understand that the sport of skiing, travel to and from the ski area and other activities with the 70+ Ski Club involve a risk of injury to all parts of my body. I hereby agree to freely and expressly assume all risks of injury while skiing, travel to and from the ski area and activities with the 70+ Ski Club. I agree that I will release the 70+ Ski Club and its officers from any and all responsibility for injuries or damages to me or to any other person. I have carefully read this agreement and release of liability and fully understand its contents. I am aware that this is a rule of liability and a contract between me and the 70+.YesNoPlease select lift ticket*You can change your lift ticket choice up until the first day of the trip. These are group tickets and should be the lowest cost options. The total will be included with your final invoice. 5-day ticket 4-day lift ticket No lift ticket needed Guest 2: Please select lift ticket for second applicant* 5-day ticket 4-day lift ticket No lift ticket needed Emergency Contact (Name and Phone Number)*Please list name(s) and phone # (s) for an emergency point of contact.Comments / MessagePlease list any special requests incuding any food restrictions, or preferred roommatesCAPTCHA70 Plus Ski Club will process your payment through PayPal. You can either pay using a major credit card or by using your PayPal account. Thank you for joining us!