Please provide as much information as possible. Items marked with an (*) are mandatory fields. Thanks again for your interest in the Alpine Valley Ski Patrol.
First Name:
Last Name:
Address:
City:
State:
AK - Alaska AL - Alabama AR - Arkansas AZ - Arizona CA - California CO - Colorado CT - Connecticut DC - Washington DC DE - Delaware FL - Florida GA - Georgia HI - Hawaii IA - Iowa ID - Idaho IL - Illinois IN - Indiana KS - Kansas KY - Kentucky LA - Louisiana MA - Massachusetts MD - Maryland ME - Maine MI - Michigan MN - Minnesota MO - Missouri MS - Mississippi MT - Montana NC - North Carolina ND - North Dakota NE - Nebraska NH - New Hampshire NJ - New Jersey NM - New Mexico NV - Nevada NY - New York OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VA - Virginia VT - Vermont WA - Washington WI - Wisconsin WV - West Virginia WY - Wyoming Not USA
Zip Code:
E-mail Address:
Home Phone:
Cell Phone:
Birthdate:
Occupation:
Have you ever been a member of the National Ski Patrol?:
Yes No
Activity:
SkierSnowboarderBoth
Please describe any of your medical training or background that may benefit the Ski Patrol.
Please describe your skiing history including classes, ski areas and number of days skied per year.: