Wilderness Defender Field Training – Albuquerque Office

Your Name:*
First Last
Your Email Address:*
Your Home Location (City, State):*
Your Phone Number:*
Please list any allergies and/or medical concerns we should be aware of. If none, type "none."*
Emergency Contact Name:*
First Last
Emergency Contact Phone Number:*
Emergency Contact Email Address:*
Are you a member of New Mexico Wild?*
- Yes
- Not Yet
You don’t need to be a member to participate.

ELECTRONIC SIGNATURE (Please type your first & last name)*
Signature Confirmation*
By signing above, I confirm that I have read and understand this document in its entirety. I voluntarily agree to waive any claim I may have against New Mexico Wilderness Alliance or its employees, directors, or agents as a result of injury or damage I may experience during my participation in the Outing.
Date*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Photo Consent*
I grant to New Mexico Wilderness Alliance, the right to take photographs of me and my family in connection with the above identified event. I authorize New Mexico Wilderness Alliance, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that New Mexico Wilderness Alliance may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.
- I consent to the photo policy above.
- I do not consent to the photo policy above.
*** If you are a minor (under age 18), your parent or legal guardian must sign this Agreement on your behalf.***
I hereby agree and consent to the foregoing Agreement on behalf of:
First Last
Name of minor
Age of minor
ELECTRONIC SIGNATURE of Parent or Guardian (Please type your first & last name)
Signature Confirmation
By signing above, I confirm that I have read and understand this document in its entirety. On behalf of the above-named Minor, I voluntarily agree to waive any claim the Minor may have against New Mexico Wilderness Alliance or its employees, directors, or agents as a result of injury or damage the Minor may experience during the Minor's participation in the Outing.

Step 1 of 3

*** If you are a minor (under age 18), your parent or legal guardian must sign this Agreement on your behalf.***

* If you are a minor (under age 18), your parent or legal guardian must sign this Agreement on your behalf.*