Eagle Hill Masthead



Application for Seminars

For a printer friendly application form, click here.

* Required fields

*Full Name
*Phone (day)
Phone (eve)
Phone (cell)
Company
Department
*Address
*City
*State/Province
*Zip/Postal Code
*Country
*Email
Age (helpful when assigning rooms)
*Gender Female  Male 
*Alumnus Institute alumnus(a)  1st time applicant 

I would like to participate in the following seminar(s):
*Title
*Instructor(s)
*Dates
Second seminar:
Title
Instructor(s)
Dates
Alternate choice:
Title
Instructor(s)
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): 2x occupancy, some 3x
Cabin: 2x occupancy, some 3x
Lodge: 2x occupancy, some 3x
Student cabin: 2x occupancy
Tent platform
Commuter

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


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 restrictions and/or food allergies we should be aware of?
No significant dietary restrictions
I am a strict vegetarian
I am a "vegetarian," but I will eat:
   Dairy
   Eggs
   Chicken
   Fish
   Shellfish
   Other:

I have the following special dietary restrictions and/or 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 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%; 20% with letter from advisor)
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? 

University credits and/or continuing education units (CEUs) are available for most seminars. Application forms are available upon arrival. There is a fee.
Would you like to earn university credits? Yes   No
Would you like to earn CEUs?  Yes   No

Are you interested in possibly carpooling if someone inquires? Yes     No
Would you be a driver or passenger?

Other pertinent information, comments, questions, etc., are welcome.

 
In case of emergency, contact:
*
Emergency contact name
*
Emergency contact phone
Each application needs to be accompanied by either a $100 deposit, purchase order, or training authorization form. Deposits are fully credited towards costs for room, board, and tuition. Balances are due upon arrival at Eagle Hill, or, in the case of purchase orders and training authorization forms, will be invoiced after the end of a seminar, unless requested earlier.

I will pay the deposit payment online. Once you "Submit" below, you have the option to go to a secure server to pay your deposit by credit card by way of PayPal.
I am e-mailing a pdf of my purchase order or training authorization form in lieu of the deposit.

Notes about payments.

I grant Eagle Hill Institute the permission to use any photographs taken of me during my participation in the above seminar(s) solely for the purposes of Eagle Hill Institute-related promotional material and publications.

How did you first hear about the Eagle Hill Institute?

How do you like to keep informed about Eagle Hill?
Website
Mailing list emails
Facebook
Twitter

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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