Visually-Impaired Participant Application

Personal Information

1. Last name: First Name:
Address line 1:
Address line 2:
City: State: Zip:
Country:
Home phone:
Work phone:
Cell phone:
E-mail address:

2. Your name, as you wish it to appear on your event name-tag, if different from above

3. Job or profession:

4. Age: Date of birth (mm/dd/yy):

5. Gender
Select One
Female
Male

6. Height: (feet, inches) Weight, necessary for guide matching: (pounds)

7. Degree of visual impairment:
Select One
high partial
low partial
totally blind

8. Do you have a hearing impairment?
Select One
Yes
No

9. Is your level of hearing sufficient for you to hear the spoken instructions of your guide while skiing?
Select One
Yes
No

Please describe any devices, such as hearing aids or assistive listening devices, that you will use to allow you to hear the spoken instructions of your guide while skiing.

10. Have you previously attended Ski for Light International?
Select One
Yes
No

If yes, number of previous events attended:

If yes, most recent year attended:
Select one 2011 (Granby, Colorado) 2010 (Provo, Utah) 2009 (Provo, Utah) 2008 (Bend, Oregon) 2007 (North Conway, New Hampshire) 2006 (Granby, Colorado) 2005 (Granby, Colorado) 2004 (Green Bay, Wisconsin) 2003 (Anchorage, Alaska) 2002 (Granby, Colorado) 2001 (Green Bay, Wisconsin) 2000 (Granby, Colorado) 1999 (Anchorage, Alaska) 1998 (North Conway, New Hampshire) 1997 (Brainerd, Minnesota) 1996 (Spearfish, South Dakota) 1995 (Granby, Colorado) 1994 (Granby, Colorado) 1993 (Brainerd, Minnesota) 1992 (Granby, Colorado) 1991 (Cable, Wisconsin) 1990 (Brainerd, Minnesota) 1989 (Bozeman, Montana) 1988 (Fairlee, Vermont) 1987 (Traverse City, Michigan) 1986 (Duluth, Minnesota) 1985 (Frisco, Colorado) 1984 (Lake Placid, New York (cancelled)) 1983 (Cable, Wisconsin) 1982 (Spearfish, South Dakota) 1981 (Saratoga Springs, New York) 1980 (Traverse City, Michigan) 1979 (Squaw Valley, California) 1978 (Deadwood, South Dakota) 1977 (Woodstock, Vermont) 1976 (Lakewood, Minnesota) 1975 (Frisco, Colorado)

11. What is your current level of cross-country skiing ability?
Select One
Beginner - Little or no cross-country skiing experience, never skied before or not yet comfortable with basic techniques.
Intermediate - Some experience with all aspects of cross-country skiing, but not yet comfortable in all areas.
Advanced - Comfortable with all techniques for traversing level ground and hills.

12. First-time participants: Briefly describe any cross-country or other skiing experience you have had:

Rooms, Meals and Other Event Preferences

13. On what day will you arrive at the Provo Marriott?
Select One
Thursday February 2
Friday February 3
Saturday February 4

14. Please indicate below your hotel rooming preference: Prices shown include room and all meals from Sunday evening February 31 through Sunday morning February 7, round-trip transportation between the Salt Lake City (SLC) airport and hotel (at designated times), transportation to/from the ski area each day, and all trail fees. Full payment is due from all accepted applicants by December 15, 2011.
Select One
Double-occupancy, in a standard hotel room with one king or two double beds, $850 per person
Single-occupancy, in a standard hotel room with one king or two double beds: $1,175 per person.

15. What is the name of your preferred roommate, if any.

16. Financial assistance: SFL recognizes that some first-time participants will not be able to attend the event without financial aid. Partial stipends are available in such situations, under the following guidelines: the amount awarded will be based on the funds that SFL has available, the applicant's demonstrated financial need, and the applicant's total cost of participating (including travel costs). Assistance is not available to applicants arriving early and/or staying late at the event hotel, to applicants with a single room, or to applicants who are not residents of the United States. If you would like to be considered for financial assistance, please indicate below your total household income and provide a narrative paragraph describing why you need financial assistance.

17. Do you anticipate bringing a dog guide to SFL?
Those planning to bring a dog guide to SFL should be aware that dogs may not be left unattended at the ski area, or allowed to run free on the ski trails. As a practical matter, dog guides must therefore be left in your hotel room while you are away skiing. Your dog will need to be able to handle several hours of being alone in your room each day.
Select One
Yes
No

18. Are you willing to room with a person bringing a dog guide?
Select One
Yes
No

19. Menu plan:
Select the menu plan that you prefer for the week. SFL strives to provide a healthy, balanced diet that is high in complex carbohydrates derived from fresh fruits and vegetables, whole grains and dairy products and low in fat. The standard and pescatarian menu options are the only menu options that will be available during the week. SFL is able to secure affordable meal prices that benefit all participants by limiting the menu options to just these two. Thank you for understanding and cooperating with these choices.
Select One
Standard - includes red meat, poultry and fish.
Pescatarian - includes eggs, dairy products and fish as well as other sources of protein (legumes and soy) but no red meat/poultry.

20. Skiing Plans or Goals for the Week:
Select the option that best describes your skiing plans or goals for the week.
Select One
I plan to ski hard over a considerable distance every day to improve my competitive skills.
I plan to ski more recreationally than competitively but to ski a good distance every day.
I plan to ski recreationally but not cover too great a distance every day.
I plan to ski at a more leisurely pace over relatively short distances.
None of the above (please explain below.)

Please provide any additional or clarifying comments on this subject:

21. Program Schedule Alternate Format:
If you would like a Braille or (18 point) large-print version of the schedule of the week's activities (in addition to the e-mail and regular print versions that everyone receives) please select desired format below.
Select One
Braille
Large print (18 point)

22. Will you need rental cross-country skis at the event?
Cross-country skis, poles and boots will be provided free of charge to first-time participants, and will be available to all others at a rental cost of $60 for the six-day week.
Select One
Yes
No

If you need rental ski boots, what size shoe do you normally wear?

Other Information

23. A list of attendees is distributed to participants at each Ski for Light event. Do you wish to include your home telephone number with your name and address on the list?
Select One
Yes
No

24. Which format would you prefer for your copies of the Ski for Light Bulletin? The Bulletin is a newsletter that informs people in the SFL community about events and activities of interest. It is distributed three times a year in print, e-mail, and cassette formats.
Select One
E-mail
Cassette
Regular print

25. First-time participants: How did you learn of SFL International? Please be specific.

Additional information or comments, if any, for Lynda Boose, the Application Coordinator:

If you have questions please contact:
Lynda Boose
Visually-Impaired Participant Application Coordinator
47440 Pilgrim Road
Houghton, MI 49931
(906) 370-7541
LBoose@up.net