Eagle Hill Masthead



Application for Eagle Hill Seminars and Workshops held at the Institute

For a printer friendly version of this application form, click here.

* Denotes required fields

*Full Name
*Phone (day)
Phone (eve)
Phone (cell)
*Address
*City
*State/Province
*Zip/Postal Code
*Email
Age (to be used when making room arrangements)
*Gender Female  Male 
*Alumnus Institute alumnus(a)  1st time applicant 

I would like to participate in the following seminar(s):
*Title
*Instructor
*Dates
Second seminar:
Title
Instructor
Dates
Alternate choice:
Title
Instructor
Dates

What are your specific interests, goals and expectations for the above program(s)?

Which of your experiences, classes, or interests are related to the above programs? What is your current career or career interest and institutional affiliation?

Residential preference, if possible:
classroom building (with lounge) double occupancy
cabin with double or triple occupancy
lodge (with lounge) double occupancy
simple cabin double occupancy
tent site
commuter

Do you have any personal habits, preferences, or concerns that you would like us to consider when assigning roommates?


Do you smoke or snore?
Smoke
Snore

Meal plan choice:
full meal plan (required for residents)
commuter meal plan (lunches and Sunday dinner required; other meals by arrangement)

Do you have any special dietary requirements or food allergies we should be aware of?
No significant dietary restrictions
I am a strict vegetarian
I am a "vegetarian," but I do occasionally eat:
   dairy
   eggs
   chicken
   fish
   shellfish
   other animal products:

I have the following special dietary requirements/allergies:


Are you fully able to participate in field trips, some of which may involve hiking over uneven and/or awkward terrain? Please indicate any concerns you might have and how we might be able to help you.

Do you have any special medical conditions we should be aware of?

Are you requesting a general discount? Only one of the following may be requested.
Institute alumnus(a) of 1 previous seminar (10%)
 Institute alumnus(a) of 2-3 previous seminars (15%)
Institute alumnus(a) of 4+ previous seminars (20%)
 University student (10%)
 Couple (10%)
 Group (10%)


If you are a student, please list your university or college. If you are an alumnus, please list seminars you have attended.

Are you requesting a general scholarship? Scholarships range from 10 - 50%. The number of scholarships is limited. Why do you think you merit and need an award? How much are you requesting? 

Sponsoring organization or agency information. Each agency form should have name of participant and seminar title, instructor, and dates.

Full payment is not due until you arrive for the seminar. If you are being sponsored by an organization or agency, will you be making payment for the seminar costs (tuition, meals, accommodations, other fees) with:      
check or credit card      
one combined purchase order or authorized training form
several separate purchase orders or authorized training forms

Applications for university credits or CEUs will be available at the seminar. There is an application fee.

Would you like to earn university credits? Yes   No
Would you like to earn continuing education units?  Yes   No
Are you interested in possibly carpooling if someone inquires? Yes    No
     If yes from where?
Other pertinent information, comments, questions, etc., are welcome!

 
In case of emergency, contact:
*Emergency Contact Name
*Emergency Contact Phone

A $100 deposit is required to register your application and save your place in the seminar.
I am faxing a copy or emailing a pdf of a purchase order to cover the  deposit payment      
I will make the required deposit payment online (Once you submit this application, you will be given the option of going to the secure server to make this payment—credit cards and PayPal accepted.)
   
I understand that during my participation in this seminar, reasonable efforts will be made to assure my comfort and safety both at the host facility and in the field. I recognize my own responsibilities in this regard. Full details on liability are available.
 

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