Wilderness Defender Outing – Cookes Range Wilderness Study Area

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:*
How did you hear about this event?*
- NM Wild email
- Social Media Post
- Another Way - describe below
How did you hear about this event?
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 assume the risks of participating in this Activity and to waive any claim I may have against the New Mexico Wilderness Alliance or its employees, directors, or agents as a result of Injuries or Damages I may experience during my participation in the Activity.
Date*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Photo Consent*
I grant the New Mexico Wilderness Alliance the right to take photographs of me and my family in connection with the Activity, and to use and publish the photographs, with or without my name, for any lawful purpose, including in digital or print media.
- I consent to the photo policy above.
- I do not consent to the photo policy above.
*** The following section must be completed if you are a minor (under age 18). Your parent or legal guardian must sign this Agreement below 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
On behalf of the above-named Minor, I voluntarily agree to assume the risks of the Minor’s participation in this Activity and to waive any claim the Minor may have against the New Mexico Wilderness Alliance or its employees, directors, or agents as a result of Injuries or Damages the Minor may experience during the Minor's participation in the Activity.

Step 1 of 3

*** The following section must be completed if you are a minor (under age 18). Your parent or legal guardian must sign this Agreement below on your behalf.***

* The following section must be completed if you are a minor (under age 18). Your parent or legal guardian must sign this Agreement below on your behalf.*