ADIRONDACK FORTY-SIXERS – Officia
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__________________________________________________________________________________________ Office Use Only-Do not Write Above Line ADIRONDACK FORTY-SIXERS – Official Form I am Registering for my Regular 46er Completion ________ I am Registering for my Winter 46er Completion ________ 46er #_____________ (If you already have one) NAME: ______________________________________________________________________________________________________________ As you wish it to appear on your Certificate of Accomplishment ADDRESS: _____________________________________________________________________________ CITY: ____________________________________ STATE/PROVINCE: ________ ZIP: ________________ COUNTRY: _________________ E-mail Address: ___________________________________________________________ Phone Number: (_______) ________-____________ DOB: _____________________ Age at time of Finish: ____________________ Gender: ___________________ Use this section if registering for Regular 46er Completion First 4,000-ft. Adirondack Peak climbed by you: __________________________________ Date: _________________________ 46th / last 4,000-ft. Adirondack Peak climbed by you: ___________________________________________________________ Date: _______________________ Exact arrival time on summit: ______________________________ AM______PM______ (month/day/year) Use this section if registering for Winter 46er Completion First Winter 4,000-ft. Adirondack Peak climbed by you: __________________________________ Date: __________________________ 46th / last Winter 4,000-ft. Adirondack Peak climbed by you: ______________________________________________________ Date: _______________________ Exact arrival time on summit: ______________________________ AM______PM______ (month/day/year) Favorite Peak: ___________________________________________ Least Favorite Peak: _____________________________________________ Mountain Elevation (Feet) Date Mountain Elevation (Feet) Date Algonquin 5114 Lower Wolf Jaw 4175 Allen 4340 Macomb 4405 Armstrong 4400 Marcy 5344 Basin 4827 Marshall 4360 Big Slide 4240 Nippletop 4620 Blake Peak 3960 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 South Dix 4060 Grace Peak 4012 Street 4166 Gray Peak 4840 Tabletop 4427 Haystack 4960 Upper Wolf Jaw 4185 Hough 4400 Whiteface 4867 Iroquois 4840 Wright 4580 Directions for Filling out Official Paperwork Before filling out and submitting the official form and your initial dues, please complete the following checklist: When filling out the 1-page official (required) form make sure: ▢ The 1-page official form is on a single side of paper ▢ DO NOT write on back of form ▢ Use black ink ONLY- no colored inks or pencil ▢ NO STAPLES ▢ Make sure every section is fully completed including a complete address ▢ Make sure your name is legible When mailing your 1-page official (required) form, and the 1-page (optional) essay make sure you: ▢ Include TWO copies of the 1-page official (required) form ▢ Include a 1-page (optional) essay ● Tell us about a favorite experience or unexpected mishap. Want to be creative? Write us an original song or poem. If you can’t write, draw us a picture that is related to your 46er experience. These may be quoted and/or used in the 46ers Peeks magazine and/or website. ▢ Make sure your complete name is on your 1-page (optional) essay ▢ Use a standard #10 (4 1/8” by 9 1/2”) regular size envelope - NO STAPLES ▢ Mail the 1-page official (required) form and 1-page (optional) essay to: Adirondack Forty-Sixers Office of the Historians P.O. Box 46 Fort Edward, NY 12828 ▢ DO NOT mail the Historians your $15 Initial Dues ▢ DO send more than 1 finishers completed paperwork in the same envelope (if applicable) When mailing your $15 Initial dues make sure you: ▢ Send your $15 Initial dues to the 46er Membership Coordinator to: 46er Membership Coordinator Adirondack Forty-Sixers P.O. Box 4383 Queensbury, NY 12804 ▢ DO send more than 1 finishers dues in a single envelope (if applicable) ▢ DO write the names of the finisher(s) in the “memo” line of a check or on a post-it note so we know who’s dues are being paid. ▢ DO NOT send paperwork or copies of your paperwork to the Membership Coordinator ▢ Finishers registering for Winter completion who are already registered AND have a climbing number DO NOT need to send in an additional $15 Initial dues payment .