**GODDARD SKI CLUB 2009 TRIP APPLICATION**

**Whitefish Montana, January 17-24, 2009**

**\$1249/per person based on double occupancy**

Please complete all information, print, sign and submit a trip deposit
check (payable to \"Goddard Ski Club\") to the Trip Leader: Tom Johnson,
Code 443, NASA/GSFC, Greenbelt, MD 20771

Each individual must submit a separate application form (combined checks
are acceptable).

> Name (first, last):
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(**exactly**
> as on photo ID)
>
> Street Address:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> City, State, Zip Code:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Home Phone: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Work Phone:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> E-Mail Address:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Age: 5 or under\_\_\_\_\_ 6-12\_\_\_\_\_ 13-17\_\_\_\_\_
> 18-64\_\_\_\_\_ 65 or over\_\_\_\_\_
>
> Male\_\_\_\_\_\_ Female\_\_\_\_\_\_\_\_ Smoking\_\_\_\_\_\_\_\_\_
> Non-smoking\_\_\_\_\_\_\_\_\_\_\_
>
> Sharing room
> with\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Need
> roommate assigned\_\_\_\_\_\_
>
> Sharing condo
> with\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Emergency Contact (person not on trip):
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Relationship:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Home Phone: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Work
> Phone: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Medical Conditions:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Medical or Drug
> Allergies:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Medical/Health Insurance Company:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Policy No.\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Phone
> No.\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> **IMPORTANT TRIP POLICIES**

All trip participants must be current members of the Goddard Ski Club.
For membership details, visit the Club website
<http://gewa.gsfc.nasa.gov/clubs/ski> or contact the Trip Leader.

Lodging rates are based on double occupancy per bedroom. If you do not
have a roommate, the Trip Leader will endeavor to assign you one. If the
Trip Leader is not successful in finding a roommate of the same gender,
you may pay the increased single room rate or cancel with a refund. The
refund amount depends upon the cancellation date and the trip contract
provisions (ask Trip Leader for details).

Reservations are accepted on a first-come basis and require deposits.
All payments must be made on schedule. This trip requires a \$500 per
person deposit and a final payment by December 15. If airline applies
fuel surcharges or increases fees, these will be **added to the final
trip payment**. Refunds for cancellation will only be made after trip
completion and to the extent that the Goddard Ski Club is able to
recover cancellation expenses. If you have an injury, illness, or other
reason for cancellation from the trip, the Trip Leader will attempt to
find a replacement, but you are fully responsible for any costs incurred
by the Goddard Ski Club.

Each trip participant is personally and solely responsible to ensure
that he/she is physically able to ski under the prevailing conditions
and that his/her ski equipment is properly maintained. Trip cancellation
insurance is NOT provided by the Goddard Ski Club, but is recommended.
The Goddard Ski Club, its officers, trip leaders, and members are not
liable for personal injury, death, or property damages involving
participants on any Goddard Ski Club trip.

I HAVE READ, UNDERSTAND, AND AGREE TO THE ABOVE TRIP POLICIES.

Signature\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_