Climbing Questionnaire - Asheville Life Insurance Strategies

Please Review Our Climbing Questionnaire for life insurance -by Asheville Life Insurance Strategies. If you have questions about this form please call:

(828) 274-1200

Name *

First

Last

Please provide first and last name. Required

Email *

Please provide your preferred email address? Required

Zip Code *

Please enter residence zip code. Required

Date of Birth *

Please enter month/date/year. Required

How many years have you been climbing? *

Enter number of years. Required

How often do you climb? *

Please enter how frequent you climb? Required

Are you a member of a Climbing Club? If so, please enter Club Name *

Please answer Yes / No. Required

Type of terrain you climb, (i.e. rock, snow/ice, artificial climbing walls) *

Please provide details. Required

Difficulty Ratings of your current climbs? *

Please enter ratings, (i.e., 5.13, NE4, A14), Required

Maximum height you have climbed to in last two years? *

Please enter altitudes of your current and recent climbs, and explain if there have been any changes? Required

Season of year when you climb? *

Please tell us which seasons of the year you climb? Required

What percentage of your climbing is on routes protected by Fixed or Placed Climbing Devices? (such as bolts, hangars, pitons, etc.) *

Please tell us percent of your protected climbs? Required

Do you ever climb alone or without a rope? If YES please state how often, location, and rating of climb? *

Please provide details if applicable? Required

Do you plan to go on any expeditions out of the US in the next 2 years? If YES, please give full details, including location, length of expedition, and frequency of trips? *

Please answer Yes / No, and If YES provide details as noted? Required

Please provide any other comments you would like to mention?

Please use this space to add any comments that you wish to make? Not required

Phone

Climbing Questionnaire – Life Insurance

Please Review Our Climbing Questionnaire for life insurance -by Asheville Life Insurance Strategies. If you have questions about this form please call:

(828) 274-1200

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