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Baxter State Park
64 Balsam Drive
Millinocket, Maine 04462
(207) 723-5140

WINTER TRIP REGISTRATION


Please print this form and mail to the above address. This Form must be mailed in with request and received by the Reservations Office at least two (2) weeks prior to departure.

Trip Dates:

Number in Party:

Destination, Proposed Itinerary, and Routes:






WINTER CAMPING PARTY NAMES

LEADER'S NAME:________________________________________

CO-LEADER #1:__________________________________________

CO-LEADER #2:__________________________________________

TEAM MEMBER:_________________________________________

TEAM MEMBER:_________________________________________

TEAM MEMBER:_________________________________________

TEAM MEMBER:_________________________________________

TEAM MEMBER:_________________________________________

TEAM MEMBER:_________________________________________

TEAM MEMBER:_________________________________________


MOTOR VEHICLE INFORMATION (FOR VEHICLES PARKED AT PARKING LOT): MAKE/COLOR/PLATE #:__________________________________

Type of payment: Check #_______________
# VISA or MASTER CARD #___________________ expiration date:____________________


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LEADER INFORMATION
Name:
Mailing Address:

Home Phone:
Work Phone:
Prior winter experience in Baxter State Park ? IN OTHER WILDERNESS AREAS?




Emergency notification
Name:
Relationship:
Address:

Home Phone:
Work Phone:


I,_______________________, ATTEST THAT TO THE BEST OF MY KNOWLEDGE, ALL MEMBERS ARE CAPABLE AND FIT ENOUGH TO ENSURE OUR SAFE COMPLETION OF OUR PROPOSED ITINERARY.

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ASSISTANT-LEADER INFORMATION
Name:
Mailing Address:

Home Phone:
Work Phone:

PRIOR WINTER EXPERIENCE IN BAXTER STATE PARK? IN OTHER WILDERNESS AREAS?




Emergency notification
Name:
Relationship:
Address:

Home Phone:
Work Phone:


--------------------------------------------------------------------------------


ASSISTANT-LEADER INFORMATION

Name:
Mailing Address:
Home Phone:
Work Phone:

PRIOR WINTER EXPERIENCE IN BAXTER STATE PARK? IN OTHER WILDERNESS AREAS?




Emergency notification
Name: Relationship:
Address:
Home Phone:
Work Phone:


--------------------------------------------------------------------------------


TEAM MEMBER INFORMATION

Name:
Mailing Address:
Home Phone:
Work Phone:
Emergency Notification Name:
Relationship:
Address:
Home Phone:
Work Phone:


--------------------------------------------------------------------------------

TEAM MEMBER INFORMATION

Name:
Mailing Address:
Home Phone:
Work Phone:
Emergency Notification Name:
Relationship:
Address:
Home Phone:
Work Phone:


--------------------------------------------------------------------------------

TEAM MEMBER INFORMATION

Name:
Mailing Address:
Home Phone:
Work Phone:
Emergency Notification Name:
Relationship:
Address:
Home Phone:
Work Phone:


--------------------------------------------------------------------------------

TEAM MEMBER INFORMATION

Name:
Mailing Address:
Home Phone:
Work Phone:
Emergency Notification Name:
Relationship:
Address:
Home Phone:
Work Phone:


--------------------------------------------------------------------------------

TEAM MEMBER INFORMATION

Name:
Mailing Address:
Home Phone:
Work Phone:
Emergency Notification Name:
Relationship:
Address:
Home Phone:
Work Phone:


--------------------------------------------------------------------------------

TEAM MEMBER INFORMATION

Name:
Mailing Address:
Home Phone:
Work Phone:
Emergency Notification Name:
Relationship:
Address:
Home Phone:
Work Phone:


Source: B.S.P.