1. Your name:
2. Age
3. I am physically fit and can do 20 sit ups and 12 push ups and am willing to demonstrate this to the instructor.
4. Do you exercise? If so explain your plan.              
   
   
   
                                                                                                                                         
5. List any health problems or concerns.

6.  Describe your experience backpacking:

7. To join this hike I am committed to attend the two orientation meetings on campus with times to be announced the end of April and the day before we depart in August.

8. I will pay either pay the full $220 fee or a $50 non-refundable fee on or before May 5 to reserve my spot. (Students who take the course for credit may use financial aid to cover these costs and can pay at any time spring semester. These costs include all travel, food, park fees, two nights at the lodge, and two guides and some equipment.)
    
9. I will meet the June 28 deadline for full payment.
    
10. I will obtain a copy of the textbook, The Backpacker’s Handbook and complete the assignments before July 28 if taking the course for credit.
     
11. I promise to abide by the Wilderness Covenant (agreeing to treat the wilderness and other hikers with respect, not to cut green trees, yell, trash or cause undo impact on the camping site.)

In typing your name, you state that the above information is correct.

Complete the form, copy and return an email to Prof. Gillespie. gary.gillespie@northwestu.edu