I'm Interested!

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Montage Mountain Ski Patrol - 1000 Montage Mountain Road - Scranton, Pennsylvania 18507

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National Ski Patrol

Montage Mountain

I am interested in becoming a member of

the Montage Mountain Safety Awareness Team!

Please provide the following contact information:

Last Name:

First Name:

Address:

City:

State:

Zip Code:

Phone Numbers:

E-Mail Address:

              Home:

              Cell:

Additional information that you wish to provide:

Date of Birth:

I have the following experience (check all that apply):

No Basic First Aid

No Advanced First Aid

PA DOH First Responder

No PA DOH First Responder

EMT

No EMT

Paramedic

No Paramedic

OEC Technician

No OEC Technician

Basic First Aid

Advanced First Aid

Yes - My age is 18 or Older

No - I am under the age of 18

Age (verify):

No Skiing

Skiing

No Snowboarding

Snowboarding