MESOZOIC OF DURANGO FIELD TRIP REGISTRATION

FOUR CORNERS GEOLOGICAL SOCIETY

THE MESOZOIC OF DURANGO FIELD TRIP REGISTRATION
THIS FORM IS FOR STUDENT REGISTRATION ONLY

If you are an Active, Associate, Emeritus or Honorary Member of the Four Corners Geological Society please use the "Professional" version of the registration form.
TRIP INFORMATION

Date: April 15th, 2023. This is a local day-trip lasting from ~8am to 4:30pm.

Leaders: Professors Gary Gianniny and David Gonzales, Fort Lewis College

Limit: 23 participants total (18 professional members, 5 students). Those who register after the limit is reached will be waitlisted and moved up as openings occur. Empty student slots will be released on April 7th to waitlisted professional members.

Registration Fee: $25/ professional members, free for students.

Cancellation: Please cancel by April 3rd, or as soon as you realize you can't go, to allow time for the organizers to fill your slot from the waiting list. Contact Kim Gerhardt (below) to cancel.

Physical Activity Level: Participants should expect to take short hikes of less than a mile at elevations ranging from 6,500' to 7,000', possibly over rough terrain and in variable weather conditions.

Transportation: Two vans from Fort Lewis College and possibly 1-2 carpool vehicles.

Food: Participants are asked to bring their own lunches and water. Water refill will be available.

More Information: Registrants will receive an email with specific instructions on the gathering location, what to bring, etc., and will be contacted if there are any changes to the plan.

Contact: Please contact Kim Gerhardt, kd@mydurango.net, 970-759-7689 cell, if you have any questions or problems with this form.
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MEMBERSHIP REQUIREMENT

ALL participants on an FCGS field trip must be current members of the FCGS. This is an insurance requirement. If you need to join or renew to go on this trip you will also receive membership for the 2023-2024 dues year (runs 6/1/2023 - 5/31/2024).

Students who are currently enrolled in a geosciences program receive free membership but they must formally join the society by filling out the online application on our website.

Please follow the link below to join or renew your membership:

https://fourcornersgeologicalsociety.org/membership/

Waiver and Release of Liability, The Mesozoic of Durango Field Trip

Please read the complete form, initial where indicated, and sign at the bottom.
The following waiver is issued by the Four Corners Geological Society as the entity organizing the field trip. Fort Lewis College, which is providing the transportation, will be sending an additional waiver closer to the time of the trip which will be forwarded to registrants to complete electronically.
Please enter your full name.*

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I hereby state that I wish to participate in the Four Corners Geological Society field trip in and around Durango, CO. I understand that the F.C.G.S. is not a professional outdoor organization. The individuals organizing and leading field trips are providing this service as unpaid volunteers. I recognize, and accept, that any outdoor activity may involve certain dangers, including but not limited to the hazards of falling rocks, temperature, weather, accidents or illness in remote locations, lack of hydration, forces of nature, insects, animals, motor vehicles as driver and passenger, and the actions of participants and other persons.

RELEASED PARTIES: By executing this release and waiver of liability and indemnity agreement, I voluntarily agree to forever release and discharge the following parties: F.C.G.S. directors, officers, agents and trip leaders, trip organizers and any public entity or public employee (whether paid or volunteer) that assists in presenting, organizing and promoting F.C.G.S. field trips.
Initials*

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RELEASE FROM LIABILITY: I hereby fully and forever discharge and release the Released Parties from any and all liability, claims, demands, losses, and causes of action whatsoever arising out of any damages, whether in tort or contract or under any statute of any nature, both in law and in equity, including claims for personal injury or death to me or damage to my property arising from the passive or active sole or concurrent negligence or other fault of any of the Released Parties, including but not limited to any claims or losses resulting from any activities in which I may engage during the F.C.G.S. field trip event, including but not limited to operating any motorized vehicle , as a passenger in any motorized vehicle, or from any other cause that may arise during the event.
Initials*

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CONTINUATION OF OBLIGATIONS: I agree and acknowledge that the terms and conditions of the above provisions shall continue in full force and effect indefinitely even upon conclusion of the F.C.G.S. field trip. I further agree that my heirs, executors, administrators, successors, assigns and personal representatives, or anyone else claiming on my behalf, shall not initiate any lawsuit, cause of action or claim for damages against any of the Released Parties.
Initials*

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MODIFICATION OF AGREEMENT: This agreement cannot be modified orally and a waiver of any provision shall not be construed as a modification of any provision herein, as consent to any other provision herein, or as consent to any subsequent waiver or modification.
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I have fully informed myself of the contents of this Waiver and Release of Liability by reading before I have signed it.
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Confidential Medical Form

Please answer the questions below and sign at the bottom. This information is for emergency use only, will not be kept past the date of the field trip, and will only be shared with the field trip Safety Officer and medical personnel.
Please enter your full name.*

First NameLast Name
Date of birth*

MonthDayYear
Date
Known dangerous allergies (please list). e.g. medicine, food, plant, animal, insect toxin. Please be aware that the Society's first aid kit does not include an EpiPen. If you have one that you might need, please bring it with you and tell the Safety Officer.
Medical Conditions

Please describe any medical condition currently requiring special care, medication or diet that can adversely affect or limit your participation in the activities described in the overview letter. These may include, but not be limited to limited mobility / hearing / sight, fear of heights, dangerous allergies, medical conditions other than those listed below, and pregnancy.
Please list medical conditions.
Do you have any of the following conditions?

AsthmaBleeding disordersConvulsions / SeizuresDiabetesFainting spellsHeart troubleHigh blood pressure
In case of emergency please contact:*

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Phone number of emergency contact:*
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I hereby authorize release of the information herein to medical personnel in case of emergency:
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REGISTRATION - FREE FOR STUDENTS
Please certify that you are a student by answering the questions below, signing your name in the signature box and clicking on the Submit button.
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FOUR CORNERS GEOLOGICAL SOCIETY

THIS FORM IS FOR STUDENT REGISTRATION ONLY

Waiver and Release of Liability, The Mesozoic of Durango Field Trip

Confidential Medical Form

REGISTRATION - FREE FOR STUDENTS