W&OD Trail Patrol Registration Form
first name
(required field)
MI
last name
(required field)
home phone
(required field)
work phone
cell phone
primary e-mail
(required field)
secondary e-mail
address (1)
address (2)
city
state/district
zip code
Please indicate the day(s) and time(s) on which you would like to partol.
The choices that you make indicate your preferences -- they do not represent commitments
.
Saturday
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Please indicate your mode of travel for the patrol.
(Check all that apply.)
on foot -- walking
on a bicycle
on foot -- jogging or running
on skates
on cross-country skis
in a wheelchair
on horseback
other
(please specify)
In case you have an emergency,
we should attempt to notify:
name
phone