70+ Ski Oregon Mar 26-Apr 2, 2022 This form is to make a deposit for the 70+ Ski Oregon trip. The form will display the full trip price, but only collect a deposit. 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 AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code 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. Please assign a roommate (2 beds in room) I prefer a single room and will pay supplement (1 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 beds 1 bed Lift ticket Guest #1Discounted group lift tickets are available for the (4) ski days at Mt Bachelor. IKON passes have benefits at Mt Bachelor. At Timberline, (2) ski days, skiers age 71+ should get complimentary tickets. 3-day Mt Bachelor ticket 4-day Mt Bachelor ticket I have an IKON pass No ticket/non-skier Lift ticket Guest #2Discounted group lift tickets are available for the (4) ski days at Mt Bachelor. IKON passes have benefits at Mt Bachelor. At Timberline, (2) ski days, skiers age 71+ should get complimentary tickets. 3-day Mt Bachelor ticket 4-day Mt Bachelor ticket I have an IKON pass No ticket/non-skier 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. If the entire event is cancelled due to COVID-19, every effort will be made to provide a 100% refund. 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 and illness 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 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 American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name Δ
