TTT 2023 Intake Form TTT 2023 Intake Form Name * Name First First Last Last Primary Email * Primary Phone * Phone Type MobileHomeWork Additional Personal Contact Info Satellite Communications Sat Phone/SMS Type, Number, Contact Link, etc. For ZOLEO, please provide assigned number. For InReach, please provide web link. Ham Radio Callsign If applicable. Emergency Contact EC Name * EC Relationship To You * EC Primary Email * EC Primary Phone * EC Pri Phone Type MobileHomeWork EC Secondary Phone EC Sec Phone Type MobileHomeWork EC Other Phone EC Other Phone Type MobileHomeWorkOther EC Other Phone Type Medical and Dietary We’re collecting this to ensure your needs can be accommodated; we want to do everything possible to ensure a welcoming and inclusive environment for everyone taking time out of their lives for this program! All responses will be kept confidential by the Wheeling Wisely Admin Team. Allergies and Sensitivities Please list any environmental, food, or medical allergies we should be aware of. Medical Conditions Please list any medical conditions or considerations we should be aware of in case urgent care is required (example: insulin-dependent diabetes). Accessibility Please list any special accessibility requirements you may have. Dietary Requirements and Considerations Accommodations Preference During Training * Camping On-SiteLodgeOther Off-Site Camping Options Ground TentRTT on VehicleRTT on TrailerTent Trailer/CamperOther Camping Options Vehicle Are you bringing your 4×4 to training? * Yes No Year, Make, and Model How many seatbelts, including driver, does your 4×4 have? * 2 Are you willing to make your 4×4 available for training purposes? Yes No This may involve not only you driving your rig, but also the instructors and perhaps other participants. Arrival and Departure Classes start bright and early on Monday, Sept. 11, and will run a full day on Friday, Sept. 15. We strongly recommend planning to arrive at least a day prior (Sunday, Sept. 10) to get settled in and have a good sleep, and not leaving until you’re well-rested the morning of Saturday, Sept. 16. If you choose to arrive even earlier or leave later, get in some local wheeling, and indulge in the camraderie, that’s even better! Please complete the last sections here so we can make sure everything is covered. Anticipated Arrival Date * Anticipated Arrival Time * MorningAfternoonEvening Anticipated Departure Date * Anticipated Departure Time * MorningAfternoonEvening Comments Anything else you’d like us to know? If you are human, leave this field blank. Submit [ Start Over ]
