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

Summer Event Application


Name________________________________________ Phone(H)____________

Address_____________________________________             (W)___________

             ______________________________________e-mail_______________

Person to contact in case of emergency:

Name_________________________________________   Phone (H)___________

Address______________________________________   (W)___________

     ______________________________________

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. Enclosed is my payment for:

_____ Maudsley State Park, Sunday, May 15, $10.00 donation

_____  Tandem  Bike  Trip, Lincoln MA June 25, $10.00 donation
 Please register by June 1st
 Please check if you can bring any of the following equipment:
  Tandem bike____  Helmet____ Extra Helmet/s_______(how many?)

_____ Chapin House,New Hartford, CT, August 19-21   $ 195 person
  Please register by July 1st
 I prefer to____ hike both days____canoe on Saturday, hike on Sunday

_____ Mt. Auburn Cemetery Walk,  Saturday, September 10, $10.00 donation

_____ Middlesex Fells hike , Saturday, October 1,$10.00 donation