International Mountain
Climbing School
2733 Main Street, Rt. 16
P.O. Box 1666
North Conway, NH 03860
PHONE: (603) 356-7064
FAX: (603) 356-6492
EMAIL: guides@ime-usa.com

 
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15th Annual
Ice Fest

16th Annual Women's
Rock Day
Expedition Registration Form
A complete and accurately filled out registration form will allow the guides at IMCS to offer the most personalized and safe climbing experience possible. If for any reason you do not feel comfortable sending us this form over the Internet, you may print this form and send it via the US mail. Thank you.
Name:
Date of Birth:
Sex: Male     Female
Email:
Mailing Address:
City:
State:
Zip:
Home Phone:
Work Phone:
   
Name of Course or Trip:
Dates:
Do you have any medical conditions we should be aware of? Yes     No
If so, please comment:
Do you have any allergies? Yes     No
If so, please comment:
Are you currently taking any medications? Yes     No
If so, please list:
Have you had any recent surgeries ? Yes     No
If so, please comment:
Do you have any
dietary restrictions?		 Yes     No
If so, please comment:
Do you carry any Medical Insurance? Yes     No
If so, please list your Insurance Company / Provider & Policy Number:
Policy Number:
Who should we contact in the event of an emergency?

Person:

Relationship:

Previous Experience
Why are you taking this course and what do you want to accomplish?:
 

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If you need any more information, you can contact us by:
Email: guides@ime-usa.com or Phone: (603) 356-7064