Application for Seminars

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

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

Residential preference, if possible.
Classroom building
Cabin
Lodge
Student cabin
Tent platform
Commuter

Do you have personal habits, preferences, or concerns that you would like us to be aware of?

Do you smoke or snore? Smoke Snore

Do you have dietary restrictions and/or allergies we should be aware of?

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 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 (15%; 30% with letter from advisor)
Couple (10%)
Group (10%)
None

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? 

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
*Emergency contact e-mail

* Each application needs to be accompanied by either a $100 deposit, purchase order, or training authorization form. Deposits are credited towards costs for room, board, and tuition. The balances is 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.

Once you click "Submit" below, you have the option to go to a secure server to pay your deposit by credit card by way of PayPal or to choose "Pay by check".

I will pay my deposit online.
I will pay my deposit by check.
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?
Found your webpage Email from a colleague, family member, or friend Advisor or supervisor Facebook page Twitter page Flyer Poster Listing by another organization Publicity at a conference or meeting Other

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.
*Signed (type your name)
*Dated