Summer 2009 Trip Applications

Name_______________________________________   Phone(H)_______________

Address_________________________________________   (W)_______________

       ______________________________________      (C)_______________
         
E-mail _______________________________________

I am a guide_____visually-impaired participant______
I need transportation to the event/s________(yes or no)
I can offer a ride to # _____ passengers ___to and ____from the event.

I wish to attend the following event/s.  Enclosed is my payment for:
___  N.H. Hiking/Kayaking Weekend, August 7-9 for $150.00/$165.00
        (Please register by July 8 with the total amount of $150)


___ Middlesex Fells Day Hike, October 3 for $10 
        (Please register by September 19)   
       
        
        
Print and mail with payment to: 

	NERSFL
	P.O. Box 861 
	Georgetown, MA 01833