Please print and complete this application, then mail or fax back to Randy or Mark. Please write clearly!

Name______________________________________________________________

Phone #__________________________Fax #_____________________________

Address____________________________________________________________

__________________________________________________________________

E-Mail____________________________________________________________

Height__________ Weight__________ Age__________ T-Shirt size__________

BASE Experience: Number of jumps__________ Time in sport__________

Buildings___________ Antennas____________ Bridges___________

Cliffs_________ Other________ Lowest BASE jump________Any injuries_____

Accuracy level: Novice______Intermediate______Advanced_______Expert_____

Type of BASE equipment you would use in the cave:

Container__________________________ Main____________________________

Reserve if any_______________________________________________________

BASE gear manufacturer______________________________________________

Owners name________________________Phone__________________________

Personal reference_________________________Phone_____________________

BASE injuries:______________________________________________________

Skydiving experience: Number of jumps__________Time in the sport__________

Drop zone you frequent:__________________________Phone________________

Pro rating: Yes / No Skydiving Injuries:_____________________________

Climbing experience: None_____ Novice_____ Intermediate_____Expert _____

First aid or CPR experience: Yes_______ No _______

List any special skills that you think would be useful during this expedition on a separate sheet.

Disclaimer:
Anyone participating in these expeditions does so at their own risk. Serious injury or even death may occur as a result of your participation. Cave BASE is designed for experienced individuals who are able to evaluate their own risk. By completing this form you are accepting these risks whether they are obvious or hidden.