Course Registration Form
Authorized Gopher Tortoise Agent Certification Training
March 5–8, 2019
Jay B. Starkey Wilderness Park
10500 Wilderness Park Blvd
New Port Richey, FL 34655
Contact us at (813) 252-6517 or info@wildlandsconservation.org
Email address *
This email address will be used for all course communications. Make sure it is an email address that can accept incoming attachments and that it is one you check regularly.
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Telephone Number *
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Address *
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Class Descriptions
Please carefully review the Class Descriptions before selecting an option below:
(http://www.wildlandsconservation.org/gopher-tortoise-authorized-agent-training-courses/course-descriptions)
Class Selection & Costs (check one) *
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Payment
Credit card / PayPal payments can be submitted through the Wildlands Conservation website. Scroll down to the Payment section at:
http://www.wildlandsconservation.org/gopher-tortoise-authorized-agent-training-courses

OR

Send check/money order payable to:
Wildlands Conservation
15310 Amberly Drive, Suite 250, Tampa, FL 33647
A not-for-profit 501(c)(3) organization (EIN number: 20-0017147)

Payment must be received up front. A cancellation within 5 working days of a regular class will be refunded at 50%. Registration is on a first come, first served basis. Registration will be considered complete once full payment is received and the registration form is signed and submitted. If we fill up quickly, then we will open another class for overflow. If the class does not get at least 7 students by at least 10 working days before the course, then it will be cancelled and rescheduled for a later date (and all registered students will receive a refund).

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Important course information
I understand that this class is both intellectually and physically demanding, and that failure to pass written exams (>80%) or field tests will result in a failure to pass the class, or specific authorized activities included in the class.

I understand that I will not receive a passing letter for specified Authorized Gopher Tortoise Agent activities if I fail to pass the class (or specific class components).

I understand that Wildlands Conservation does not offer refunds of course costs or additional testing attempts if I fail to pass the course (or a specific class component). Failure to pass any part of the course will require me to register for the next available class at the regular rate if I wish to pursue any additional attempts to become authorized for specific activities as an Authorized Gopher Tortoise Agent through Wildlands Conservation.

I understand that FWC charges a separate one-time mitigation contribution of $532 to become an Authorized Gopher Tortoise Agent, and that this fee is not included in the course costs paid to Wildlands Conservation.

Be prepared for field conditions and bring sunscreen, a reusable water bottle, insect repellent, and appropriate clothing/footwear.
I have read and understand the information above: *
A copy of your responses will be emailed to the address you provided.
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