SKIPPER MANUAL ACKNOWLEDGEMENT OF RECEIPT & EMERGENCY CONTACT INFORMATION

First Name

Last Name

Address Line 1

Address Line 2

City

State

Zip Code

Mobile Phone

Home Phone

Work Phone

Emergency Contact Info

Name of emergency contact/person with daily float plan(s)

Emergency Contact Phone Number

Skipper Vehicle Make/Model

Vehicle Color

License plate number

Monitor Skipper Program Manual Receipt

Please check the box below

I have received, read and agree to abide by the Maine Island Trail Association Monitor Skipper Program Manual. I am aware that checking the box to the left acknowledges receipt and will be retained by MITA.

Date

Trouble with the form? Email stewards@mita.org or call (207) 761-8225