TEXAS MOUNTAINEERS MEMBERSHIP APPLICATION
Send completed and signed application with appropriate dues payable to the Texas Mountaineers ($30.00 single; $40.00 couple) to: Texas Mountaineers P.O. Box 190593 Dallas, TX 75219 *Application will NOT be processed if this form is not completed and signed*

Name _________________________________________ Date of Birth ______________________

Address _________________________________________________________________________

City _______________________________________ State ____________ Zip ________________

Home Phone (_______)____________________ Work Phone (_______)_____________________

Email Address ___________________________________________________________________

Have you climbed before? Yes _______ No _______

If you have climbed before, please also complete 1) to 4):

1) Where do you climb? ____________________________________________________________

________________________________________________________________________________

2) How frequently do you climb? Often _______ Occasionally _______ Seldom _______

3) What types of climbing? (Check all that apply)

______ Top-roping	______ Traditional lead climbing	______ Mountaineering
______ Bouldering	______ Sport climbing	______ Ice climbing
______ Gym climbing	______ Aid climbing	______ Alpine
Other _________________________________________________________

4) At what grades do you regularly climb? ______________________________________________

List all formal training or instruction you have received that relates to climbing or mountaineering (include all training that you have received in safety or first aid):

	Date	Type of Course	Where Given
1
2
3