Name: ______________________________________________ DOB:
____________________
Address: ______________________________________________________________________
______________________________________________________________________________
Are you a seasonal resident of the Adirondacks?: Yes or No. If Yes, please add
Seasonal contact
info on the back of this form with your preference of how we should contact you.
Email Addresses: _______________________________________________________________
Text Message Address: __________________________________________________________
Home Phone: ________________________ Work Phone: ______________________________
Seasonal Phone: ______________________ Cell Phone:
________________________________
Your preference of how we should contact you. List all methods in order of your
preference:
______________________________________________________________________________
Special skills, licenses & certifications:
_________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Medical conditions & allergies:
______________________________________________________
______________________________________________________________________________
Notes: ________________________________________________________________________
______________________________________________________________________________
Membership Classification Choice: Field Administrative Associate Professional
If Field member are you “Winter Ready?” (Winter Gear, Snowshoes, Experience) Yes
or No
(Explanation of Membership Classifications)
Will respond to searches outside CASART area
(Yes or No, and how long are you willing to travel in hours)
______________________________________________________________________________
For Internal Use: Initiation Fee: $15.00 Paid Dues: $10.00 Paid
Hat, CASART & NYSFEDSAR Patches & Membership Card Issued