Bushmasters Registration Form:
Fax completed form to 506-231-3816 or email completed form to registration@.bushmaster-survival-school.com

Full name as it appears on your passport (must have at least 6 months until expiration)
Passport number and issuing country
Birth date
Height
Weight
Mailing address
Email address
Home phone
Business phone
Cell phone
Any medical conditions: Please list all
Blood type
Allergies of any kind
Medications you are presently taking
Handicaps or limitations? Please be precise.
Emergency contact
Relation Phone number Relation Phone number Relation Phone number
What kind of shape are you in:	Excellent Good Fair Average Couch Potato
Security Code:

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You don´t have to be in perfect shape¨to complete this course but we will be hacking our way in the bush about 2 kilometers per day and carrying about 30 pounds each, depending on what you bring.

A deposit for the full amount is due upon acceptance into our next scheduled class. If we don´t receive it in our Jacksonville account (wiring instructions attached) within 7 business days after acceptance we will offer the slot to the next applicant.

We only have 12 slots open for each class and they fill very rapidly. Don´t forget to ask a close friend if they would like to participate with you. THIS IS A TEAM EXERCISE.
Each participant will be teamed with another during the seven days in country

We recommend you purchase insurance for this class at www.travelinsured.com. We take every precaution necessary to insure our safety during this training, but we can not be responsible for unforeseen acts of nature or accidents.

You will be required to sign a release form (found on our web page) prior to acceptance into our next class. Please review, sign and fax the Release Form along with the Registration Form.