Lookout Pass Prime Timers Program



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Prime Timers Registration

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* Required Field

This Application is for:

Individual Couple

*First Name:

*Last Name:

*Phone:

*Address:

*City:

*State:

*Zip:

Emergency Contact:

Emergency Contact Phone:

-----------------------------------------------Applicant ------------------------------------------------------------ Spouse/ Partner --------------------------------

Born:

year day month

Occupation:

Retired:

yes no

*Email:

Interest in Volunteering:

Committee Member Secetary Treasurer
Coordinator Web Site Maintenance
Assist

Activities:

DH Ski XC Ski Snowshoe Hike
Camp Canoe / Kayak Golf
Tennis Bike
Other:

If applying as a couple provide the follwing:

Spouse or Partner's First Name:

Spouse or Partner's Last Name:

How did you hear about us:

Did a member recommend us?

yes no

Name of any Referral:

Please select how you want to receive your copy of the Prime Timers Newsletter This choice affects you and your partner if you are applying as a couple:

Internet copy with Email notification:

USPS Mail Copy Only:

Both USPS Mail and Email notification:

Also within the Prime Timers Club, Lookout will be offering a "Master Skiers" Ski School which will foster a Skier Improvement / Learning Program. This program will help improve physical strength, endurance and skills. It will help improve your balance when moving and learn advanced safety precautions. It will help you relax and improve reaction timing and visual accuracy. It will also help in creating better lung power or breathing capabilities.

Please check the box if you have an interest in this program: