Name : __________________________________________________________ Address: _________________________________________________________ _________________________________________________________________ City: ______________________________ Province: _____________________ Postal Code: _________________________ E-mail: _____________________ Phone Number: (H)_______________________(W/C) _____________________
How did you hear about the guide school? ________________________________
_________________________________________________________________
I would like to register for the May 4th – 13th, 2007 Level 1 $1690 + GST = $1,791.40
Previous White water experience: _______________________________________ _________________________________________________________________ _________________________________________________________________
Previous Rafting Experience: ___________________________________________ _________________________________________________________________ _________________________________________________________________
Yes, I have First Aid Certification. Exp. Date: __________________
Yes, I have CPR Certification. Exp. Date: _____________________
Yes, I have Swift Water Rescue Certification. Exp. date: _________________
To reserve a space, please fill out registration form and enclose an $800 deposit (balance of $901.30 due three weeks prior to commencement of course). This course is non-refundable within three weeks of course commencement. You will be required to fill out a medical form and a release of liability. Methods of payment: Visa, Master Card, or Money Order (no personal cheques). Visa and Master Card payments can be made over the phone or please send money orders to the address below:
#203 – 3823 Henning Drive Burnaby, BC V5C 6N5 1-800-663-7238/604-734-8622/Fax 604-734-5718 email: info @ hyak.com
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