RegisterPlease complete this form to register for a climb.Registration Step 1 of 333%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 FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneMobileEmail* Enter Email Confirm Email NOTE: We have been experiencing issues with messages from @yahoo.com email addresses being marked as spam on our server. If you have an @yahoo.com email, please consider using another for this form.Trip InformationTrip*Please enter the name of the trip you want to register for.Trip Start Date* Date Format: MM slash DD slash YYYY Previous ExperiencePlease list your climbing/skiing experience as well as any related activities.Rental Gear* Ice Axe Crampons Day Pack Mountaineering Boots Trekking Poles Insulated Jacket - "Puffy" NonePlease check which gear you will need to rent from us. Click on a link above to view a photo of the item.Shoe SizeShoe TypeMensWomensEmergency Contact InformationSomeone who will NOT be on the trip with you.Name First Last PhoneRelationshipMedical HistoryMountaineering, Rock Climbing and Ski Mountaineering are dangerous, demanding activities and are very serious undertakings. Many of our programs take place in remote settings where rescue is difficult and definitive care is far away. Additionally, most of our programs require a relatively high level of physical activity for a considerable length of time. Being physically fit is very important, and can make dealing with hazards less dangerous. Thank you for taking the time to accurately answer all of the questions on this form.Current ConditionPlease describe your physical conditioning program and your general fitness level:Medical Conditions Epilepsy Asthma Diabetes Heart Disease Seizures Altitude Sickness Vision or Hearing Impairment Chronic Headaches Shortness of Breath Chest Pain Back Problems Broken Bones Severe Sprains Hospitalization in the Past YearDo you now have, or have you ever had any of the following conditions? If you answer 'Yes' to any of the following conditions, please explain in the space provided.Condition DetailsPlease elaborate on any 'Yes' responses from above.Dietary RestrictionsDo you have any foods that you are allergic to or prefer not to eat? Please explain with details.PrescriptionsAre you currently taking any prescription medications? If Yes, please list medications and dosage, which is kept confidential.AllergiesAre you allergic to any foods, medications, or insect bites/stings? If yes, please explain what you are allergic to, the reaction, and treatment required.Other ConditionsDo you have any other condition that could affect your performance during physical activity, including your ability to run, lift, climb, or ski? If yes, please describe.Trip Prepartion & Climber Requirements Before submitting your registration form, please take a moment to read our trip preparation and requirements.Requirements* I AgreeI have read the Trip Preparation and Climber Requirements, understand it, and agree to its terms.Initials*Enter your initials as a signature.Cancellation/Refund Policy Before submitting your registration form, please take a moment to read our cancellation and refund policies listed on our Policies page.Cancellation/Refund Policy* I AgreeI have read the Cancellation/Refund Policy, understand it, and agree to its terms.Initials*Enter your initials as a signature.Complete Your Registration You're almost done... just confirm your information and click the Register button below.Newsletter? Yes, sign me up!Would you like to sign up to receive updates and newsletters from Timberline?How did you hear about Timberline?From a friendInternet searchBrochureAnother websiteUsed you beforeOtherWhich website?Other?Tell us more...Registration Completion* I AgreeAll of the information I have provided on this form is complete and accurate to the best of my knowledge.Initials*Enter your initials as a signature.Privacy* I consent to my submitted data being collected and stored according to TMG's privacy policy.NameThis field is for validation purposes and should be left unchanged.