ADIRONDACK FORTY-SIXERS - Questionnaire & List of Mountains Please answer ALL questions on front page, fill in the List of Mountains on back, include $8 initial dues* payable to ADIRONDACK 46ERS and return to: Adirondack Forty-Sixers, The Office of the Historian, P.O. Box 46, Fort Edward, NY 12828 (*This fee is waived for one member at each aspiring 46ers address) Use this form only and print using black ballpoint/ink - no pencil. Incomplete forms will be returned to climber. NAME _______________________________________________________________________________________________________________ As you wish it to appear on your Certificate of Accomplishment ADDRESS ___________________________________________________________________________________________________________ CITY ____________________________________ STATE ______________________ ZIP ________________________________________ E-mail Address ___________________________________________________________ Phone Number (_______) ________-____________ Your Age ______________ Male: _________ Female: ____________ Occupation: _________________________________________________ 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 _____________________________________________________________ 100 (or less) word autobiography: (Please use this space only.) _________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ Describe any unusual incidents or experiences you encountered. These may be quoted in the 46ers Peeks magazine and website. _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Thank you. 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. NAME OF CLIMBER: ___________________________________________ ELEVATION MOUNTAIN FEET DATE Climbers with You Remarks Algonquin 5114 Allen 4340 Armstrong 4400 Basin 4827 Big Slide 4240 Blake Peak 3960 Carson Peak (South Dix) 4060 Cascade 4098 Cliff 3960 Colden 4714 Colvin 4057 Couchsachraga 3820 Dial 4040 Dix 4857 Donaldson 4140 Emmons 4040 Esther 4240 Giant of The Valley 4627 Gothics 4736 Grace Peak (East Dix) 4012 Gray Peak 4840 Haystack 4960 Hough 4400 Iroquois 4840 Lower Wolf Jaw 4175 Macomb 4405 Marcy 5344 Marshall 4360 Nippletop 4620 Nye 3895 Panther 4442 Phelps 4161 Porter 4059 Redfield 4606 Rocky Peak Ridge 4420 Saddleback 4515 Santanoni 4607 Sawteeth 4100 Seward 4361 Seymour 4120 Skylight 4926 Street 4166 Table Top 4427 Upper Wolf Jaw 4185 Whiteface 4867 Wright 4580 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 March 2013] .