Family Earth Activist Training: Winter 2018 Registration
January 6th - 12th, 2018, Cazadero, CA, United States
Primary Contact Information
First Name *
Your answer
Last Name *
Your answer
Email *
Your answer
Mailing/Street address *
Your answer
City *
Your answer
State (Province/Region - Non U.S.) *
Your answer
Country *
Your answer
Zip Code *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
Referral information *
Where did you hear about this course? From an event or website? Please be specific.
Your answer
Family Registration Information
Please list the names and ages of the family member(s) you are registering:
Your answer
Emergency Contact and Medical Information
All information will be kept confidential. Please email us at if you have any questions.
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Physical Special Needs
If you or your family member(s) have any physical special needs or are differently abled, please let us know, and indicate any needs here.
Your answer
Mental Health Needs
If you or your family member(s) have any mental health needs that might affect your participation in the course, please let us know.
Your answer
Rideshare Program
Our rideshare program allows our registrants to connect with each other to give and receive rides. Details will be provided by those who offer or request rides in the section below. Ride coordination is organized within the two weeks leading up to the course.
Carpool/transit info *
To help us facilitate transportation to and from the course, please let us know how you will be getting here:
Ride Offer *
Can you offer a ride to fellow course participants? (more details in following questions)
Ride Offer details
Please let us know where you are driving from and how many people (and their bags) you can take in your vehicle.
Your answer
Ride Needed details
If you are flying in and need to arrange transportation from the airport, please indicate that here as well as your flight, train, or bus arrival information. Often we can arrange rides from near Oakland or San Francisco airports, but if that is not possible we will arrange a pickup from the Santa Rosa transit hub which is served by Airport Express (
Your answer
Accommodations *
The accommodations for this course are shared, dorm style rooms, please bring your own linens or cash/check to rent bedding from Black Mountain for $5/day. If you have any questions about accommodations, please contact us at
Food Information
EAT bases its food budget based on your answer to the following, and we shop for specific amounts of meat, vegetarian and vegan options based upon the information that students provide us. We can easily accommodate common food allergens, please indicate below, but please note that we cannot accommodate for folks with very specific dietary requests, such as raw and live foods. We also cannot change our food order after it has been placed. So while the food is delicious and enticing, please do not change your mind on the options below after the course has started, and please choose an option now. If you have any questions about your specific food needs, please contact us at and we can create a solution together.
Dietary preference for Primary Contact *
Please check any food allergies that you have:
Please list dietary preferences and food allergies for each additional family member here:
Your answer
Special Food Needs
If you or your family member(s) have a severe, life-threatening food allergy (such as peanuts), be sure we know! Please indicate any needs or food allergies here. If you answered "Other" above, please explain here:
Your answer
Terms and Conditions *
No-Refund Policy: Deposits and payments are absolutely nonrefundable if you cancel for any reason. However, deposits may be transferable to a future session, minus a $100 administration fee. (In the unlikely event that we must cancel the course, all monies paid, including your deposit, will be refunded.) Full tuition payment is required by the registration deadline, December 23rd, 2017, or you may forfeit your reserved spot. Due to financial commitments made to the event venue, we are unable to issue refunds after this date. Any registrations received after December 23rd must be submitted with full payment. By clicking below, I am asserting that I have read and understood the NO-REFUND policy.
Payment Method *
Please select a payment method. When you complete this form, you will be directed to the course page where you can process your payment via the method you indicated.
Cost: $695-$995 sliding scale per adult/child pair; $275 each add/l child
I will pay in full now
I will pay a deposit of 50% now
$695- Scraping by, I truly cannot afford more
$795- True cost of attendance
$895- Resilient tuition- I am working and/or solvent
$995- Abundance tuition- I want to help others attend
Custom amount for more than one adult/child pair
How to pay:
Thank you for registering for the upcoming training. We are looking forward to your presence! To finalize your registration, please go to the following webpage to enter in your payment:

Our coordinator will contact you within the week with an email confirmation of your registration and payment. Please don't hesitate to contact us with any questions in the meantime, at Thank you!

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