The Louisiana Hiking Club
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Copyright 2005 - The Louisiana Hiking Club

Last Updated On:  12/30/2015
Initial that you have read and
accept the wavier (for example:
Type SD for Sam Doe)
No
Yes
Guest/Non-Member on a hike:
Date of Hike  
Location or  Name of Hike
First Name:
Middle Name:
Last Name:
Date of Birth:  (Optional)
Street Address:
City:
State:
Zip:
Home Phone:
If desired, enter a word after the phone,
number to describe it.
Like:  555-555-5555 Cell
Work, Cell or other
Phone (Optional):
Email address:
Email address (again):