Pre-registration Form for VIC Outings

Please complete the information on this form to register for a Newcomb APA-VIC sponsored outing. A confirmation email will be sent within 48 hours.
In the event we are out on a trip, we will respond as soon as we return. Thank-you.

Feel free to contact us with any questions you may have.

Name:

# in party:

Address:

City:

State/Province:

Zip/Postal Code:

Country:

P.M. phone:

Home phone:

Outing destination:

Outing date:

E-mail:

Email more info? (Y or N)

API member? (Y or N)

Please list any medical conditions, concerns, questions or comments you may have here.