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2. Disclaimer
   Information submitted on this form will be sent via unsecured email. To protect sensitive information, do not enter the following items or similar information on this form: Social Security numbers, driver’s license numbers, bank account information, routing numbers, credit card numbers, medical information, passport numbers, and passwords. Please review our privacy policy located at www.jeffco.us/privacy. By submitting this form, you acknowledge and accept the terms listed in the privacy policy.
4. Fixed Hardware Application

   This form is to be completed by anyone wishing to join the citizen based fixed hardware review committee which reviews all applications for new climbing hardware installation on JCOS managed land.

6. Contact Information
8. First Name*
9. Last Name*
11. Address*
13. Address Line 2
15. City*
16. State*
17. Zip Code*
18. Country
20. Phone Number*
21. Email Address*
25. 1) Please describe your experience with rock climbing and/or slack-lining (i.e. how long have you been participating in these activities, what grades you climb, where you like to climb, etc.)*
27. 2) Please describe any professional outdoor experience that you may have.*
29. 3. Do you have any affiliations with local business or organizations that relate to rock climbing or slack-lining along the front-range?*
31. 4. Please describe your experience with setting climbing or slack-lining routes using fixed hardware. Be sure to add the type of hardware that you used and the method of installation.*
33. 5. What does conservation mean to you?*
35. 6. What is your favorite area in Jefferson County Open Space and why?*
37. 7. Please explain why you want to serve on this committee.*
39. 8. Please explain your view(s) of route and crag development.*
41. 9. Do you have any prior engagements scheduled for the weeks following December 1st, May 1st, and August 1st of the upcoming year that would inhibit your ability to attend a meeting?*
45. Electronic Signature Agreement*

    I (we) hereby swear or affirm, under penalty of perjury, that the information given here is true and correct. The typed signature below indicates this individual, or the legal entity the individual represents (as applicable), accepts responsibility for the activity and agrees to the terms and conditions of this agreement.

    1. I agree to the terms and conditions
47. Electronic Signature*
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field