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Pu'u Kukui Nature Hike
APPLICATION FOR GENERAL PUBLIC

DEADLINE FOR APPLICATIONS IS JULY 31, 2000. THOSE CONFIRMED TO PARTICIPATE ON THIS HIKE WILL BE NOTIFIED NO LATER THAN AUGUST 4, 2000.


NAME OF APPLICANT:
EMAIL ADDRESS:
MAILING ADDRESS:
CITY:
STATE/ZIP: /
TELEPHONE: (day/work)
(eve/home)
AGE: years
(minors, 17 years and younger, are not eligible to participate unless authorized by Maui Pineapple Company, Ltd.)
WEIGHT: lbs. (for helicopter weight requirements)
* HEALTH RESTRICTIONS:
List all:

       

*Please include a signed release from your physician to participate in this activity if you are currently taking any prescribed medication for any treatment requiring a physician's care. Please see PHYSICAL REQUIREMENTS on the previous page.



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