SKIING AND CLIMBING SKILLS QUESTIONNAIRE
MR/MRS
MS/MISS
GIVEN NAMES
(AS SHOWN ON PASSPORT)
SURNAME / LAST NAME
(AS SHOWN ON PASSPORT)
NATIONALITY
OF PASSPORT
HEIGHT
(INCHES/CMS)
WEIGHT
(POUNDS/KGS)
Date of Birth
(dd/mm/yy)
Name by which you wish
to be known (if other than above)
Street Address
City
Region
Country
Home Phone
+
Work Phone +
Mobile
+
Email
What is your
first language?
Post Code
How well do
you speak English?
WHICH EXPERIENCE ARE YOU INTERESTED IN AND WHAT EXPERIENCE DATE?
(Please include the date below the experience of interest)
Ski Antarctica
Climb Antarctica
Mount Vinson
Mount Sidley
Ski the Last Degree
SKI EXPERIENCE
How many years downhill skiing?
How many years cross-country skiing?
How many years backcountry/randonnee/alpine touring?
Have you ever pulled a pulk/sled when skiing?
When backcountry/randonnee/alpine touring, what type of system do you use? Telemark
How frequently have you been skiing
in the last 2 years?
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Skiing and Climbing Skills Questionnaire 2016
Randonnee
Downhill days:
Off-piste days:
Backcountry/randonnee/
alpine touring days:
Cross-country days:
3478 South Main Street
Salt Lake City, UT 84115 USA
+1 801-266-4876
www.antarctic-logistics.com
List below any ski touring trips that you have done
Month/
Year
Did you have a
guide?
Region/Route
Distance Skied
Number
of Days
MOUNTAINEERING/CLIMBING EXPERIENCE
How many years have you been mountaineering/climbing?
Please list the areas where you have been mountaineering/climbing.
Which season?
WinterSummer
WinterSummer
WinterSummer
WinterSummer
WinterSummer
Have you ever been rock climbing?
YesNo
Lead FollowTop-Rope
Have you ever been ice climbing?
YesNo
Lead FollowTop-Rope
How frequently have you been mountaineering/
climbing in the last 2 years?
# of 1-2 day trips:
# of 7+ day trips:
Where:
Date:
Guided:
Yes
No
Have you worked as a guide in the mountains?
Yes
No
If so, provide details:
Has the majority of your mountaineering/climbing been unguided?
YesNo
Do you have roped glacier travel experience?
YesNo
If so, where/when?
Have you climbed out of a crevasse using prusiks or mechanical ascenders?
YesNo
If so, where/when?
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ANTARCTIC LOGISTICS & EXPEDITIONS
List below the major mountaineering/climbing trips (single peaks/traverses/climbing ares) that you have done.
Month/
Year
Mountain
Did you use a guide
company? If so, please list.
Route
Highest altitude
reached?
Did you
summit?
WINTER OUTDOOR EXPERIENCE
Do you have experience winter/snow camping in a tent? Please give details.
How many years have you been active in the winter?
Location
# of Nights
Guided?
Temperature
Date
YesNo
YesNo
YesNo
Have you ever camped at altitude?
YesNo
Highest altitude you have camped? (feet/
metres)
How frequently have you done these activities in
the last 2 years?
# of 1-2 day trips:
# of 7+ day trips:
Where:
Date:
Guided:
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ANTARCTIC LOGISTICS & EXPEDITIONS
First Aid Experience and Training
Your guide is trained in first aid, but you will be climbing or skiing in a remote
setting and it is helpful to know the first aid experience of all team members.
Do you have any first aid experience/training?
YesNo
If so, please tell us the organization you trained with and when you received a certification form.
FITNESS, TRAINING, AND OTHER EXPERIENCE
Physical Fitness
How often do you exercise? Please check the box to the right that best describes your level of activity.
In good health, but do not have a regular exercise routine.
Mainly exercise 1-2 times a week (e.g. a weekend hike, visit to the gym, short jog).
Exercise 2-3 times a week with cardiovascular sessions lasting more than 45 minutes.
Exercise more than 4 times a week with a mix of interval and cardiovascular sessions.
Can you hike uphill for 6-8 hours carrying a 25 kg/55 pound pack without being
exhausted the next day?
YesNo
When did you last do this?
Any Other Information
Please list below any other experiences you may have had which may be relevant to a skiing/climbing expedition i.e.
marathons, triathlons, endurance events, extended backpacking trips, biking (road or mountain), multi-day adventures etc.
Do you have a fitness routine leading up to your expedition?
YesNo
I declare that the information above is a fair representation of my skiing, climbing and mountaineering experience. I also
declare that I know of no reason that should prohibit me from taking part in the expedition or that would jeopardize other
team members or myself.
Name:
Signed:
Date:
ALE reserves the right to check your credentials.
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ANTARCTIC LOGISTICS & EXPEDITIONS