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ISLAND ECOLOGY REGISTRATION FORM

(Please fill out completely)

Name:
E-Mail:
Gender:	Male Female
Date of Birth:
Address Line 1:
Address Line 2:
City:
State:
Zipcode:
Phone:
How did you find us?:

What is the best time to call you? :

Please describe your physical ability to swim and hike:

Please describe in detail why you would like to take this course:

Please describe any special needs or considerations you might have:

Send your $200 refundable deposit in the form of check, money order, or cashier chedk to the Discovery Institute, 1342 Wilson Ct., Arroyo Grande, CA 93420. If you wish to pay for your deposit using a credit card please use the following link to PAYPAL.

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PH: (805) 481-0037 FAX: (805) 481-3315

EMAIL: info@institutefordiscovery.org

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