NSW Backcountry Weekend Self-Assessment

Name *

Other participants name & phone no. (if booking for more than 1)

Phone *

Street Address *

Email Address *

Gender *FemaleMaleOther

I am happy to share with: *Another maleAnother femaleAnyoneAnother ticketholder - name provided below

Name of other ticketholder you wish to share a room with

Dietary Requirements/Allergies?

Do you suffer from asthma? If yes, please provide us with your Asthma Management Plan

Do you have a medical condition or take any prescription medications which may affect you during vigorous exercise? If yes, please detail:

Rate your fitness level between 1 and 10, 10 being most active

What sports or fitness activities do you do regularly and how often?

Are you a skier, telemarker or snowboarder?

Approx how many days on average will you have spent skiing/riding this season & the last 2 seasons?

How comfortable do you feel on steeper slopes (black runs) (1-10 with 10 being very confident)

Have you been in the snow backcountry either in Australia or overseas before? If yes, please give a brief description:

What backcountry touring equipment and/or avalanche safety equipment do you own (if any)?

Friday Afternoon Tour

Yes I am available for Friday afternoon tourNo I cannot make snowcat by late morning Friday.

Will you be on snowcat to Charlotte Pass (leaving late morning Friday). If not, please give details below.

Comments/requests

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