PWRF 2010 Montana Dig Registration
Name
Name
Name
Name
Name
Additional Participants
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Gender
under 15
15 to 20
21 to 29
30 to 39
40 to 49
50 to 59
60 and over
under 15
15 to 20
21 to 29
30 to 39
40 to 49
50 to 59
60 and over
under 15
15 to 20
21 to 29
30 to 39
40 to 49
50 to 59
60 and over
under 15
15 to 20
21 to 29
30 to 39
40 to 49
50 to 59
60 and over
under 15
15 to 20
21 to 29
30 to 39
40 to 49
50 to 59
60 and over
Age Group
June-July 2010
Contact Details
Name
Address
City
State
Postal code
Phone
E-mail
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia
Botswana
Bouvet Island
Brazil
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Caicos Islands
Cape Verde
Cayman Islands
Central African Rep.
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Czechoslovakia
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Sth Ter.
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Great Britain (UK)
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea (North)
Korea (South)
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Kitts - Nevis
Saint Lucia
Samoa
San Marino
Sao Tome - Principe
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovak Republic
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
St. Helena
St. Pierre
Sudan
Suriname
Svalbard
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Tobago
Trinidad
Tunisia
Turkey
Turkmenistan
Turks
Tugalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
USSR (former)
Uzbekistan
Vanuatu
Vatican City State
Venezuela
Vietnam
Virgin Islands (G.B.)
Virgin Islands (U.S.)
Wallis and Futuna Is.
Western Sahara
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
1st. Choice Start
1st. Choice Finish
2nd Choice Start
2nd. Choice Finish
enter prefered Start/Finish Date:
Payment Details
Card Type
Visa
Mastercard
Name on Card
Card Number
Expiry
01
02
03
04
05
06
07
08
09
10
11
12
/
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
Expedition fee: Adult: $135.00 per day;pp
0 1 2 3 4 5 6 7 10
Expedition fee:*Child: $70.00 per day;pp
How many children?
# dig days?
0 1 2 3 4 5 6 7 8 9 10
0 1 2 3 4 5 6 7 10
*Child 15 & under :
Interested in Base Camp Meals?
Interested in Base Camp Lodging?
$ total price: $ -20% deposit: $ Balance due:
20% down to hold reservation.
Balance due 30 days prior to camp arrival.
0 1 2 3 4 5 6 7 8 9 10
How many Adults?
# dig days?
