Alpine Adventures - Mountain Adventures In The Adirondacks Since 1985 - Instruction & Guiding For Rock Climbing, Ice Climbing, Mountaineering And Backcountry Skiing
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Personal Information Form

Submitting Personal Information
This form is for your convenience. It will submit your contact and other information to us via email. With your personal information on file we can quickly, and easily, contact you with confirmations for our programs, specific information you might request, and general information about Alpine Adventures, Inc.

Submitting this data does NOT register you for Alpine Adventures, Inc. programs. Please contact us so we can discuss your goals, experience and scheduling requirements. This will enable us to be sure we select a program that is just right for you at a time when we are available. You may also wish to go to the Arrange An Adventure page to learn more.

Privacy Notice
We respect your privacy! Personal information provided to Alpine Adventures, Inc. will never be given, sold or bartered to anyone for any reason. Period. We do, infrequently, contact our clientele via email or US Mail to keep them informed of happenings at Alpine Adventures but don’t expect to hear from us more than a few times each year. If you would prefer we not contact you with any mailings please email us and we will remove your name from our mailing database.

Caption omitted to protect privacy!

My Personal Information Is: new an update to existing information.
Contact Information:
First Name (required)
Last Name (required)
Email Contact Information:
Email Name (required)
Primary Email Address (required)
Phone Contact Information: Please include area code.
Phone
Address Information:
Address
City
State
Zip Code / Postal Code
Country
Personal Information:
Gender Male Female
Birthdate (mm/dd/yyyy)
Height
Weight

Medical Information:
We require that you inform us of any medical conditions you have that could make our activities particularly hazardous for you, and for others who may entrust their safety to you during these activities. Please describe, in the strictest confidence, all of your medical conditions. Problems such as dizzy spells fainting, heart condition, seizures, severe allergic reactions, incompletely healed injuries or any other conditions that could temporarily incapacitate you must be brought to our attention. If you have no medical conditions, please write NONE.

Medical Conditions:
:
In Case Of Emergency, Please Notify:
Name
Phone Number
Relationship To You
Previous Related Experience:
Rock Climbing
GymTop-RopingFollowingLeading

Ice Climbing
Top-RopingFollowingLeading

Mountaineering
SummerWinterAlpine

Backcountry Skiing
On TrailsOff Trails

Specific Experience:
How did you hear about us? Word of Mouth
Web Search
Advertisement / Listing
Other
Comments:

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~ Mountain Adventures In the Adirondacks Since 1985 ~

Alpine Adventures, Inc.
10873 NYS Route 9N, P.O. Box 179
Keene, New York 12942 USA

(518) 576-9881

Copyright © 2004-2015 Alpine Adventures, Inc.