Membership Form
Founder: Tom Wagar        email twagar @  adventureheads .  com     night 716.636.5700    day 716.691.1926
President: Dave Ditullio   email trailslammer @  yahoo .  com    night 716.773.0021   day 800.343.1354

How did you hear about AdventureHeads? _______________________________________________

Circle the topic you want to learn more about

Adventureheads Racing       Guided Tours                    Upcoming Races/events        Equipment Rentals
Orienteering                            Website                              Adventureheads Club              Kayak Skills
Canoe Skills                            Rock Climbing                 Mountain biking                         Back Packing
Basic Survival Skills               CPR/1st Aid                      Training Camps                        Corporate Seminars
Corporate Sponsorship        Marketing                           Other __________________________________
Name:  ____________________________  email:   ______________________________________

Address:  _______________________________________________________________________

Day Phone: ________________________   night phone: __________________________________

Emergency Contact Name: ________________________________
       
Emergency Contact Phone: ________________________________

Current Occupation (optional):  ______________________________________________________
AdventureHeads membership discounts:
*  Discounts on all AdventureHeads certified clinics such as paddling, fixed rope, mountain biking, navigation, etc.
*  Discounts at local and online Outdoor stores
*  Discounts on local area orienteering topographical maps
AdventureHeads membership details:
As a result of our first successful year we are able to reduce our 1 year membership fee to $10 (a great deal when other similar clubs charge in excess of $25)

Your first outing with AdventureHeads is free so you can decide if Adventure Racing is for you.  The membership fee,  completed Membership Form and Waiver Form are due at your second outing.  Our events page lists numerous activities in the greater Western NY area.  

Mail form to:  Adventureheads, C/O Tom Wagar, 160 Plantation Ct, E Amherst, NY 14051

We look forward to seeing you at our next AdventureHeads outing.
"RU Headed for an Adventure"                  www.adventureheads.com                 Rev 11, October 03, 2004