70+ Ski Utah Feb 25- Mar 4, 2023 This form is to make a deposit for the 70+ Ski Utah trip. 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?* 1 2 Are you a club member?*Family members and friends of members are welcome to participate! Yes No Name* First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Date of Birth MM slash DD slash YYYY Phone2nd Person Name and Date of BirthName* First Last Date of Birth* MM slash DD slash YYYY Please choose your rooming situation.You can make any special requests, such as your preferred roommate, in the comments section at the end of this form. All suites also have an outer room with a pullout sofa. Please assign a roommate (2 queen beds in room) I prefer a single room and will pay supplement (1 King bed) Please choose your rooming situation.You can make any special requests, such as your preferred roommate, in the comments section at the end of this form. All suites also have an outer room with a pullout sofa. 2 double beds 1 King bed Total $0.00 Additional InformationI 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. Yes No How will you arrive? by Air by Auto Please 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*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 understand the risks associated with COVID-19. 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, illness, 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+ Ski Club. Yes No Group Lift tickets - Skier #1In order to save everyone time and money, group lift tickets will be purchased for the group at certain resorts. The final price will be set in the Fall and will be included in the final invoice. The price will be based on your age and should be the lowest price option available. Unused tickets should be fully refundable. (For example, you take day off.) Please list any resorts below you will NOT need a ticket because you have a season pass. I have NO season passes with benefits in Utah I have an IKON Base pass (Solitude & Brighton) I have an IKON Base PLUS pass (adds Alta, Snowbasin, Deer Vly) I have an EPIC Pass with benefits at Park City I have a Mountain Collective pass I'm a non-skier or need no tickets Group Lift tickets - Skier #2In order to save everyone time and money, group lift tickets will be purchased for the group at certain resorts. The final price will be set in the Fall and will be included in the final invoice. The price will be based on your age and should be the lowest price option available. Unused tickets should be fully refundable. (For example, you take day off.) Please list any resorts below you will NOT need a ticket because you have a season pass. I have NO season passes with benefits in Utah I have an IKON BASE pass (Solitude, Brighton) I have an IKON BASE PLUS pass (adds Alta, Snowbasin, Deer Vly) I have an EPIC Pass with benefits at Park City I have a Mountain Collective pass I'm a non-skier or need no tickets 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 including any food restrictions, or preferred roommatesCAPTCHACredit Card (**only the deposit will be charged, but the form shows the total trip cost**) American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name Δ
