Lynx Tracking Expedition - Registration 2019
Please complete one form for each person you are registering.
Contact Info
First Name *
Your answer
Last Name *
Your answer
Email *
Your answer
Address (Street) *
Your answer
Address (Town/City) *
Your answer
Address (State/Province) *
Your answer
Address (Zip) *
Your answer
Phone 1 *
Your answer
Phone is: *
Personal Information
Date of Birth *
MM
/
DD
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YYYY
Any significant dietary restrictions or allergies?
Your answer
Anything else you want to us to know about your participation in the trip?
Your answer
Scholarship Application
The Great Blue Heron Scholarship Fund provides tuition reductions for this and other VWS programs. The average scholarship rate we offer is 20-30% OFF the low end of the sliding scale. Scholarship applications are due 3 weeks before the first day of a program, but the sooner you apply the better your chances. We will reply within 2 weeks of receiving your request.
$ Amount of scholarship funds I am requesting:
Your answer
Please share any information you choose about your scholarship request.
Your answer
Payment
$ Program Fee for this Single Registration *
Sliding Scale; $410 – 575 sliding scale, true cost is $500
Your answer
$ My Donation to the Scholarship Fund
The Great Blue Heron Fund provides over $30,000 per year in scholarship funds VWS programs. Consider donating the full cost of another person's registration! Your donation is tax deductible.
Your answer
$ Total I Owe *
Program Fee +PLUS+ Donation
Your answer
$ Amount I am paying TODAY for this single registration *
A deposit of $150 is required to reserve a slot. Full payment is due February 1st.
Your answer
I will be paying today via: *
If you will be using a PayPal Payment account associated with a different name than the one used in this registration, please let us know!
(This helps us associate your payment with your registration.)
Your answer
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