Fall Ecology and Harvest Event Registration
October 13-14, 2007 (Saturday-Sunday) at Lost Valley Educational Center, Dexter, OR
Name:____________________________________________________________
Address:__________________________________________________________
Phone(s):__________________________________________________________
Email:____________________________________________________________
School (if student):__________________________________________________
Name #2:_________________________________________________________
Address:__________________________________________________________
Phone(s):__________________________________________________________
Email:____________________________________________________________
School (if student):__________________________________________________
Conference and Meal Fees (including four organic vegetarian meals, Sat. lunch and dinner, Sun. breakfast and lunch):
__$95 early registration, students ages 12 and above, until Sept. 15, 2007
__$105 regular registration, students ages 12 and above
__$125 early registration, non-students, until Sept. 15, 2007
__$135 regular registration, non-students
A limited number of worktrade opportunities and partial scholarships are available; please see the application for worktrade scholarship. We are also now offering a $10 discount/rebate on your own registration fee for each paying registrant who first hears about this event from you, or who cites you as his or her primary influence in considering attending.
Lodging: __$30/adult dormitory accommodations, Saturday night
__$20/minor dormitory accommodations, Saturday night (under 18; must be accompanied by parent or guardian)
__$10 camping per person, Saturday night
Nature Center Membership Contribution (receive e-newsletters and other member benefits, and help support the Nature Center):
__$25 __$50 __$100 __other: $____
Scholarship Donation (help others with limited funds attend this gathering):
__$25 __$50 __$100 __other: $____
Total Payment (pre-surcharge): $____
Payment method: __check (payable to Lost Valley Center) –or– __credit/debit card:
Type:________ Expiration date:_________Number:____________________________
Name on card:_______________________
Please add 5% surcharge for credit/debit card payments: $____ Total: $____
Additional Questions:
How did you hear about this event?__________________________________________
Can you offer a ride? (if yes: when, and from where?)________________________
Would you like a ride? (if yes: when, and from where?)________________________
Do you have any additional suggestions or questions?__________________________
Please submit completed form to nature AT lostvalley.org (copy and paste into an email) or print and mail to Fall Ecology and Harvest Gathering, LVEC, PO Box 55, Dexter, OR 97431 USA. You may also call 541-937-2567 ext. 116.
Name:____________________________________________________________
Address:__________________________________________________________
Phone(s):__________________________________________________________
Email:____________________________________________________________
School (if student):__________________________________________________
Name #2:_________________________________________________________
Address:__________________________________________________________
Phone(s):__________________________________________________________
Email:____________________________________________________________
School (if student):__________________________________________________
Conference and Meal Fees (including four organic vegetarian meals, Sat. lunch and dinner, Sun. breakfast and lunch):
__$95 early registration, students ages 12 and above, until Sept. 15, 2007
__$105 regular registration, students ages 12 and above
__$125 early registration, non-students, until Sept. 15, 2007
__$135 regular registration, non-students
A limited number of worktrade opportunities and partial scholarships are available; please see the application for worktrade scholarship. We are also now offering a $10 discount/rebate on your own registration fee for each paying registrant who first hears about this event from you, or who cites you as his or her primary influence in considering attending.
Lodging: __$30/adult dormitory accommodations, Saturday night
__$20/minor dormitory accommodations, Saturday night (under 18; must be accompanied by parent or guardian)
__$10 camping per person, Saturday night
Nature Center Membership Contribution (receive e-newsletters and other member benefits, and help support the Nature Center):
__$25 __$50 __$100 __other: $____
Scholarship Donation (help others with limited funds attend this gathering):
__$25 __$50 __$100 __other: $____
Total Payment (pre-surcharge): $____
Payment method: __check (payable to Lost Valley Center) –or– __credit/debit card:
Type:________ Expiration date:_________Number:____________________________
Name on card:_______________________
Please add 5% surcharge for credit/debit card payments: $____ Total: $____
Additional Questions:
How did you hear about this event?__________________________________________
Can you offer a ride? (if yes: when, and from where?)________________________
Would you like a ride? (if yes: when, and from where?)________________________
Do you have any additional suggestions or questions?__________________________
Please submit completed form to nature AT lostvalley.org (copy and paste into an email) or print and mail to Fall Ecology and Harvest Gathering, LVEC, PO Box 55, Dexter, OR 97431 USA. You may also call 541-937-2567 ext. 116.