| Organization: Whistler Blackcomb Freestyle Ski Club EMail: info@freestylewhistler.com |
| Gender: | Female |
| Date of Birth: | Nov 12, 1995 |
| Address: | usa |
| City: | albama |
| Province: | British Columbia |
| Country: | Canada |
| PostalCode: | 46382 |
| Emergency Contact Name: | +17148680120 |
| Telephone #: | +17148680120 |
| Emergency Contact Phone #: | +17148680120 |
| Athlete's EMail: | |
| Health Care # or Insurance Policy #: | 4354356 |
| Please list any medical/allergy/dietary concerns or previous injuries the coaches should be aware of: | 4354356 |
| I give my consent to allow WBFSC to use these images: | Yes |
| Name of Person Agreeing to this Film/Photo Consent: | movies |
| I acknowledge that I have read and accept the above waiver: | Yes |
| Name of Person Agreeing to this Release of Liability: | movies |
$0.00 SubTotal: | |
$0.00 Processing Fee: | |
$0.00 Total Due: (CAD) | |
3471496 Receipt # | |
| A copy of this receipt has been e-mailed to zoubaier@su8006.com | |
Thank you for registering for the Airbag Programs Please meet your coach at the Airbag 10 minutes before your session starts. Note that all participants need: helmet, non-broken ski edges and to listen to the coaches directions. Failure to do so will result in removal from the session. Questions regarding registration can be forwarded to info@freestylewhistler.com |