Application form for Spring 2003 Program Online Application Form MENU Home Agenda Mountaineering Heritage Interpretation Equipment Staff Expenses Requirements Application Rationale Bridges-PRTD Rolwaling Resources Contact Us Enrollment in Summiters is limited to 12. Early application is recommended. No application will be considered final until the $300 deposit is received. Application fee is $25. This fee is non-refundable, but counts toward the $3800 program fee. A $200 early-payment discount will be applicable if payment in full is made within 2 months of application. Applications will be processed within three days. Upon notification of acceptance, a $300 deposit must be placed within one month. The deposit is non-refundable, but also counts toward the program fee. Upon acceptance, applicants will be asked to furnish a simple statement from their doctor certifying that their is no medical impediment to participation in the program a signed waiver indicating their understanding of the hazards inherent in such a program and their assumption of those risks Prior to departure, all applicants will be required to furnish a copy of their comprehensive insurance policy, including medical, theft, evacuation, and cancellation coverage. Applicants who elect the "Just-Do-It" option, in which all academic components are waived, need not supply the academic and professional information requested below. 1. Personal Data First Name Middle Name Family Name Suffix Female Male Gender mm 01 02 03 04 05 06 07 08 09 10 11 12 / dd 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / yyyy 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 Date of Birth Address (Street, Number, Apt.) City State or Province Postal ("Zip") Code Country - - Phone (e.g. 412-555-1212) Email Address 2. Educational Background Current or most-recently attended educational institution Highest Degree (eg: MA, Physical Geography) Date Degree Completed or Expected (mm/yyyy) Other educational institution attended Other Degree Degree Date (or dates of attendance) Other educational institution attended Other Degree Degree Date (or dates of attendance) 3. Professional Experience Current employment (if applicable) Position Dates of employment Other applicable employment Position Dates of employment Other applicable employment Position Dates of employment 4. Objectives Please explain why you wish to participate in Summiters.

Summiters Application Fee The application fee for Summiters: Rolwaling Mountaineering School is $25. It will be refunded if for any reason the application is rejected. If the application is accepted, the $25 will count toward the $3800 total ($3600, if early payment conditions are met). These payment options are accepted: personal check if drawn on a U.S. bank Western Union Paypal credit card -- you may use the secure service of Authorize.Net Online Credit Card Payment Facility Enter the amount you are remitting: Amount in US $: Please contact us us if there is any problem with this payment facility.

219 W. Spencer St. #3
Ithaca, NY 14850
Tel: (609) 256-0102
Tollfree from within 48 contiguous States: 1-800-839-3023
Fax: (708) 575-6620
Email: etters@bridges-prtd.com