Alaska Master
Guides
& Outfitters

Plan your Adventure

For you next adventure, please complete the form below:

*Your Name:

Address:

City, State & Zip:

Home Phone: Work: Cell:

Type of Work: Position:

Age: Weight: Height:

Physical Condition: Excellent Good Fair Poor

Who do we contact in case of an emergency? : Name Phone :

Do you plan on physical training prior to this adventure?

Do you have any health/physical limitations? (eg emphysema; cardiac; diabetes; sports injuries; back problems; etc)

Provide the name and phone number of your doctor whom we would contact in a medical emergency

Are you on medications that may require specialized attention? (eg insulin needing to be kept cool)

Do you have any allergy issues or allergic reactions?

Do you have special dietary requirements?

Do you: get airsick? get seasick? fear heights? smoke?

Date of last physical checkup

*Previous experience:

Who referred you to Glacier Guides, Inc.?

Date: Signature:

*Security code: