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First name

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Last name

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Email address

 
  

WILDERNESS EXPERIENCE

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Have you completed your 10 day wilderness experience?

If you have not yet completed the 10 day wilderness experience, estimate your plans to the best of your ability. 

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Location of trip

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Dates of travel

Outfitting company (if applicable)

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Description of trip criteria

 
  

WILDERNESS / OUTDOOR SKILLS

Wilderness travel / backpacking

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Skill level

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Number of years

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Average number of days per year

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Have you formally instructed others (e.g. as outdoor educator) in this skill?

 
  

Leave-no-trace camping

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Skill level

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Number of years

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Average number of days per year

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Have you formally instructed others (e.g. as outdoor educator) in this skill?

 
  

Camp craft

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Skill level

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Number of years

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Average number of days per year

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Have you formally instructed others (e.g. as outdoor educator) in this skill?

 
  

Rock climbing

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Skill level

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Number of years

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Average number of days per year

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Have you formally instructed others (e.g. as outdoor educator) in this skill?

 
  

Canoeing / kayaking / rafting

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Skill level

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Number of years

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Average number of days per year

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Have you formally instructed others (e.g. as outdoor educator) in this skill?

 
  

Horseback riding

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Skill level

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Number of years

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Average number of days per year

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Have you formally instructed others (e.g. as outdoor educator) in this skill?

 
  

Horticulture / gardening

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Skill level

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Number of years

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Average number of days per year

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Have you formally instructed others (e.g. as outdoor educator) in this skill?

 
  

Ropes or challenge course

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Skill level

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Number of years

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Average number of days per year

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Have you formally instructed others (e.g. as outdoor educator) in this skill?

 
  
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Are you able to carry a 40 lb pack off trail for 10 miles in a day?

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What first aid training have you had?

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What first aid certification do you have?

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Any additional information you would like us to know about your outdoor / wilderness experience.