King Of Prussia Ski Club, Pa

Registration/Release Form Complete the fields below, then select Print to create the form. Read it, sign it and send it with payment, if applicable, to the ski trip or activity leader. Please make checks payable to KOPSC or King of Prussia Ski Club.
Check one:	Member Non-Member *Must be a member in good standing to participate in ski and sailing trips
Activity:
Activity Date:	( mm/dd/yyyy)
Name:	(as it appears on your driver's license/picture ID)
Address:
City:
State:
Zip Code:
Evening Phone:	- -
Day/Cell Phone:	- -
E-mail:	(leave blank if there is no e-mail address)
In event of emergency
Emergency Contact:
Contact Phone:	- -
Contact City:
Contact State:
Relationship:
Please list any medical alert information or allergies / medications:


Is this an overnight trip:	Yes No
Are you a Smoker:	Yes No
Preferred Roommate:	(Courtesy dictates that you let them know of your request)
Other information needed for this trip or activity (please refer to advertisement, e.g. ability level, t-shirt size etc.)