Swiftwater Rescue Course Application, 2013
To enroll, please confirm availability by calling Program Director Steve Harris at 575-751-1269, emailing him at
or contacting sponsor at: Far-Flung Adventures Box 707 El Prado, NM 87529
toll-free: 800-359-2627, fax 575-776-1443, e-mail:
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:________
City: _________________________________ State: __________________ Zip: _____________
E-Mail (important for receiveing reading materials)____________________________________
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_________
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: _________