2017 SCGS Field Trip Registration Form
Field Trip Timing: November 3rd-5th, 2017
Field Trip Location: Mecca Hills
Contact us at scgs.mgmt@gmail.com
Email address *
Attendee Information
Please complete the questions below
First Name *
Your answer
Last Name *
Your answer
Phone Number *
Your answer
Email *
Your answer
Address *
Your answer
Fee Information and Agreement
The Fees for the 2017 South Coast Geological Society Field Trip are as follows:

Regular Member: $175

Student: $100 (First 10 students); $150 thereafter [Email scgs.mgmt@gmail.com for student scholarship code]

Non-Member: $195

Optional: Student Sponsorship: $75

This cost includes camp site fees, food from Dinner on Friday night to lunch on Sunday and everything in between (6 meals total), beverages (beer, wine, water, soda), 5 port-a-potty’s, a printed Road Log book (when finalized), and 2017 Field Trip Guidebook (when published).

Select *
Required
T-shirt size
Total Fee to be Paid *
Your answer
I understand that I will have to pay for the field trip (at a meeting, eventbrite, mail-in check, etc) *
Required
Method of Planned Payment
SCGS Field Trip WAIVER
The participant is advised that dangers and hazards may include but are not limited to uneven ground, steep trails, poison oak, heat and cold stress, poisonous reptiles and insects, open flames, uncertain and possible extreme weather conditions, floods, earthquakes, road hazards, sun burn, and landslides on the SCGS field trip planned for November 3-5th, 2017, and does hereby assume any and all risks involved in connection with the field trip and does hereby save and hold harmless SCGS, its volunteer officers and other participants, all claims, losses and damages (including attorney’s fees and any costs involved because of said claims) on account of injury, death, property damage, and inconvenience or loss of money due to delay that may arise, by reason of participant involvement in the field trip. Participant understands that they (the participant) are responsible for carrying their own medical and auto insurance.
I HAVE READ THIS AGREEMENT, I UNDERSTAND ITS CONTENT, AND INTENTIONALLY AND VOLUNTARILY SIGN THIS AGREEMENT. *
Required
Write Full Name *
Your answer
Date *
MM
/
DD
/
YYYY
Emergency Contact Information
Please complete the emergency contact information for your safety
Name of Emergency Contact
Your answer
Phone Number of Emergency Contact
Your answer
Miscellaneous Information
Please answer the following questions to the best of your ability.
What days will you attend? *
Required
Dietary restrictions *
Are you willing to serve as a Team Leader to act as lead of a group of 10 vehicles, responsible to maintain space between vehicles to protect desert tortoises and ensure trash is picked up at each spot ?
Transportation
Do you have First Aid or EMT training? (for BLM permits)
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google.