Wilderness First Aid Class

27-28 Sep 2008

Application

     Please complete and return with a check for $95 payable to "Sierra Club Loma Prieta Chapter" to:

Tom Morse

1188 Walnut Street

San Carlos, CA  94070-4910

     Applications will be handled as nearly as possible on a first-come, first-served basis except that Sierra Club members will receive preference until two weeks before the class.

Name __________________________________________________________________

Mailing Address _______________________________________________________

City _______________________________ State _____ ZIP __________________

Home Phone (desirable)    __________________________

Work Phone (optional)     __________________________

E-Mail (if any) ____________________________________

Sierra Club Membership Number ______________________

Are you less than 18 years old?

What are your wilderness interests (backpacking, peak climbing, river running, etc.)?

If you are, or have been, a Sierra Club outing leader, please summarize that experience:

If the class is full, would you prefer to be kept on a waiting list or have your application canceled and your check returned immediately (circle one)?

                Wait List                             Cancel