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Please fill out the following form to join the Pocono Barrett Ski Club for the
2004 / 2005 season. You will receive confirmation by e-mail within 48 hours.

Fields marked with * are required, please press 'submit' after completing the form.

Welcome to Alpine Mountain...

*First Name:

*Last Name:

*Email Address:

*Address:

Address1

*City:

*State

*Zip:

*Day Phone:

Alpine Mountain ... The Friendliest......Family Fun Place in the Poconos.

6 Weeks of Lift Tickets $ 120.00

6 Weeks of Lifts and Ski Rentals $ 170.00

6 Weeks of Lift Tickets & Snowboard Rentals $ 180.00

6 Weeks of Lift Ticket and Lesson $ 160.00

6 Weeks of Lift Tickets, Lessons and Ski Rentals $ 210.00

6 Weeks of Lift Tickets, Lessons and Snowboard Rentals $ 230.00

6 Weeks of Helmet Rentals $ 25.00

6 Weeks Lessons Only (Season Pass Holder). $ 40.00

By submitting this form I give my permission for the following people to ski or snowboard during the 2004/2005 season with the Pocono Barrett Ski Club. I realize the sport of skiing/snowboarding can be dangerous and entails certain risks. I understand Johanna Parke & Eleanor Price along with Alpine are arranging this program for the convenience and economy of the participants and they or their family members cannot be held responsible for any accidents that may happen either in going to or at Alpine Mountain or coming from Alpine Mountain. I will not hold Johanna Parke, Eleanor Price, their families or Alpine Mountain liable for any injuries to myself, my child/children or any family members.

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Sub Total:$

Please supply the billing address for your credit card, if different from above.

Name on Card:

Address:

Address1:

City:

State:

Zip:

Total amount to be billed to your credit card:$

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Visa M/C
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