Mobility Impaired Registration
January 16th - 18th, 2009

If you don't get a confirmation within one week, please inquire.
Sometimes these things get lost in cyberspace.

The cost for the weekend found under "Lodging" includes your meals, lodging, insurance and membership.

We provide a sit ski for your use during the weekend. If you have your own please bring it.

If you have any questions about this form, contact Jim Ellickson at (989)224-8288 or e-mail:

A waiver form must be signed to attend. Print a copy sign and bring it with you. Look in the index for the form.

As an alternate to registering on line, you may print this form and mail it to:

Michigan Ski for Light
810 W. Park Street
St. Johns, MI 48879

Michigan Ski for Light recognizes some prospective skiers will be unable to attend without financial aid. Partial stipends are available in such situations. If you would like to be considered for financial assistance, please send a separate letter to Kathy Emig at or snail mail to: 509 N. Spring St., Harbor Springs, MI 49740. Please include your name, address, your total household income, and a narrative paragraph describing why you need financial assistance. This information will be kept strictly confidential.

IMPORTANT NOTICE: Do not use the enter/return key
while filling out this form. It will immediately submit the form and you will have to start over.

First name: Last name:

Address:

City: State:Zip:

Home phone: Work phone:Cell phone:

E-mail:

Date of birth (mm/dd/yy): Gender:

Skiing Ability

As Michigan Ski for Light is an instructional program, we need to know the skills of participants to match with guides. What is your current level of cross-country skiing ability?
Beginner: , Intermediate: , Advanced:
Have you previously attended Michigan Ski for Light? Yes No
Have you previously attended Ski for Light International? Yes No

Comments about your mobility impairment.

Do you have a hearing impairment? Yes , No Explain:

Lodging


We stay at the Ralph A. MacMullen Conference Center located on the north shore of Higgins Lake. They are able to accommodate Vegetarians, please mark your meal choice below.

Standard: includes red meat and poultry.
Vegetarian: includes eggs, dairy products & fish.
Note: On Saturday night you have a choice of entrée. Fish or Steak

The cost for the weekend is $102.00 except those wishing to stay in the Strait the cost will be $162.00. Make check out to Michigan Ski for Light or M.S.F.L.
Choose your room preference.
$102 for one of the Great Lakes Lodges.
$162 for the Straights.
There are two single beds per room. Please indicate the name of your roommate or we can assign one.
Name:
Note: If you request a room by your self there will be a $30 additional charge.
Comments:

Medications

List all medications (including times / dosages) you will be taking during this event.
Note: You are responsible to bring and take your own medications.
List:
Make sure that you have your insurance card with you.

Travel

What are your transportation plans? Please contact Kevin Ridsdale if help is needed.
Explain:

EMERGENCY INFORMATION

Person to be notified in case of emergency:

First name: Last name:Address:

City: State:Zip:

Home phone:Work phone:

Cell phone:

After filling out the form please hit the submit button

Updated: 10/20/08