Swiftwater Rescue Course Application, 2008 To enroll, please confirm availability by calling Program Director Steve Harris at 505-751-1269, e-mailing him at unclergr@laplaza.org or contacting sponsor at: Far-Flung Adventures Box 707 El Prado, NM 87529 toll-free: 800-359-2627, fax 506-776-1443, e-mail: farflung@taosnet.com

Registration closes 14 days prior to start of course. Applications must be received before that time.

Please enroll ___ persons in :___Swiftwater Rescue for River Professionals on

Date:_____________

Name(s): ________________________________ Age: ____

Height:___' ___" Weight:________

Address: ___________________________________________________________________________

City: _________________________________ State: __________________ Zip: _____________

Affiliation: _________________________________________________________________________ ____

Work Phone: ________________________________ Home: ____________________________

Reason For Seeking Enrollment: ________________________________________________________

Swiftwater Hazards In My Area: _________________________________________________________

PAYMENT ENCLOSED: Tuition Amount: $__________________.

____ I request an Invoice to accompany attached purchase order #______________ _____

Check Or Money Order (Payable To Far Flung Adventures

_____Bill My Major Credit Card: ___Visa___Mastercard___American Express___Discover Card #______________________________________Expiration Date_________Card Code_______

By signing below, I (authorize use of credit card for amount stated)/certify that I have basic swimming ability, am in good health, have (or can obtain) personal protective gear as outlined in gear checklist, and am able to participate in course.

Signature: _________________________________________________ Date: _________