______Office Use Only- Do Not Write Above Line

ADIRONDACK FORTY-SIXERS - Questionnaire & List of Mountains

***Directions*** Follow Directions Closely. Incorrectly completed forms will be returned to the climber. 1) Use these official forms ONLY 2) DO NOT write on back of forms 3) Print Clearly 4) Use BLACK INK ONLY 5) Completed forms should be 2-pages in length when printed.

Mail Completed Forms to: Adirondack Forty-Sixers, Office of the Historian, P.O. Box 46, Fort Edward, NY 12828.

Each Climber Should Mail $10 Initial Dues to the Treasurer: Adirondack Forty-Sixers, Membership Coordinator, P.O. Box 4383, Queensbury, NY 12804

NAME: ______As you wish it to appear on your Certificate of Accomplishment

ADDRESS: ______

CITY: ______STATE / PROVINCE: ______ZIP: ______COUNTRY: ______(Abbreviation) (If other than USA) E-mail Address: ______Phone Number (______) ______-______

Your Age: ______Male: ______Female: ______Occupation: ______

First 4,000-ft. Adirondack Peak climbed by you: ______Date: ______(Month/Day/Year)

th 46 / last 4,000-ft. Adirondack Peak climbed by you: ______

Date: ______EXACT arrival time on summit: ______(Month/Day/Year)

How did you come to climb the 46? Describe any of your favorite/ least favorite memories/moments while climbing the 46. These may be quoted in the 46ers Peeks magazine and website. If you don’t have enough space please include a one page letter along with the official paperwork:

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Page 1 of 2 ADIRONDACK FORTY-SIXERS - OFFICIAL LIST OF MOUNTAINS Elevations listed are from the most recent USGS survey. While four of the peaks are under the original 4000-or-more-mark, you must climb them to become an Adirondack Forty-Sixer.

Submission of completed Questionnaire and Official List of Mountains are required to become a Recorded Forty-Sixer.

Climber Name: ______

ELEVATION ELEVATION MOUNTAIN FEET DATE MOUNTAIN FEET DATE Algonquin 5114 Iroquois 4840 Allen 4340 Lower Wolf Jaw 4175 Armstrong 4400 Macomb 4405 Basin 4827 Marcy 5344 Big Slide 4240 Marshall 4360 Blake Peak 3960 Nippletop 4620 Carson Peak (South Dix) 4060 Nye 3895 Cascade 4098 Panther 4442 Cliff 3960 Phelps 4161 Colden 4714 Porter 4059 Colvin 4057 Redfield 4606 Couchsachraga 3820 Rocky Peak Ridge 4420 Dial 4040 Saddleback 4515 Dix 4857 Santanoni 4607 Donaldson 4140 Sawteeth 4100 Emmons 4040 Seward 4361 Esther 4240 Seymour 4120 Giant of The Valley 4627 Skylight 4926 Gothics 4736 Street 4166 Grace Peak (East Dix) 4012 Table Top 4427 Gray Peak 4840 Upper Wolf Jaw 4185 Haystack 4960 Whiteface 4867 Hough 4400 Wright 4580

Preference of peaks and why:

1. ______

2. ______

3. ______

Peak(s) least enjoyed and why: ______

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Did you become a new 46er alongside any family member(s) or friend(s)? NO _____ YES ______

Name(s) of family member(s) or friend(s) who became new 46ers at the same time as you:

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Now that you have finished the 46 please consider participating in the club's volunteer projects (listed on the 46er website) to give something back to the mountains.

[Revised July 2017] Page 2 of 2