New England Regional Ski for Light 
P.O. Box 2170 
West Brattleboro, Vermont 05303 
781-667-9270 
www.nersfl.org   Summer 2004 Event Application 


Name__________________________________________ Phone (H) _____________

Address_______________________________________ Phone (W) _____________

City, State, Zip ________________________________ email _________________ 

Person to contact in case of emergency: 

Name__________________________________________ Phone (H) _____________

Address_______________________________________ Phone (W) _____________

City, State, Zip ________________________________ 

Relationship ____________________________________

I am a guide ___ vision impaired participant 

I need transportation to the event/s ________ (yes or no)

I wish to attend the following event/s 

	
__________ Tandem  Bike Trip. Lincoln MA June 12 Please register by June 1st
Please check if you can bring any of the following equipment: 
Tandem bike _____ Helmet _____ Extra Helmet/s _____(how many?) 

__________ Cranmore  Mountain Lodge. August 13-15 Please register by June 1st
I prefer to _____ hike both days _____ boat on Saturday, hike on Sunday 

__________ Middlesex Fells hike. October 2 Please register by June 1st



Enclosed is my payment/deposit for:   

_____ Tandem Bike Trip, $10 donation 

_____ Cranmore Inn, North Conway, NH $165 person ( $25 deposit, balance of $140 is due on July 23rd) 

_____ Middlesex Fells hike, $10 donation 
   
 
Current NERSFL Board 
Carolee Miller- President 
Joe Aibinder- Vice President 
Earle Prentiss- Treasurer 
Sandie Page- Secretary
Gil Busch
Laurie Gregorio
Marie Hennessy
Joanne Jordon
Esther Levegnale
Cindy Wentz