2010 Registration Form
Registration Form
PVSC Racing Development Program
Session #1: January 2, 9,16, 23, 2010
Session #2: January 30, February 6 ,13, 27
Participant:__________________________ DOB:_________ Gender: M F
Parent/Guardian:____________________________________________________
Address:____________________________________________________________
E-mail address of parent:_______________________________________________
Home phone:_________________ Cell phone:____________________
Second emergency contact (name, phone, address):
___________________________________________________________________
Please circle the enrollment fee(s) that apply to you: (You must be a PVSC member to race --- non-members can join PVSC below)
PVSC member? (circle one) YES
NO (please enclose $25 for individual, $30 family membership in addition to program registration fee below)Racing program session registration fee:
$90 /session (for those without season pass to New Hermon Mountain)
$30/session (for those with season pass to New Hermon Mountain)
Make checks payable to: Penobscot Valley Ski Club
Mail registration form and check to: Tara McKechnie
503 Reach Road
Sargentville, Maine 04673
Alpine skiing and ski racing are inherently dangerous sports. I acknowledge those risks and grant permission for my child to participate:
___________________________________________________________________
Signature of parent or guardian
Date***Registration is on a first-come first-serve basis - sign up NOW!
***Skiers who are not paid in full will not be allowed to participate
***All skiers must wear a helmet to participate