Melting Ice in Vermont
September 4-5, 2008 Intensive Registration Form
Please print legibly when completing this form.
One form per workshop participant.
Name
Mailing Address
Day Phone
Evening Phone
Email Address
I enclose a check for $240.00 made payable to "
EarthWalk Vermont
"
(EarthWalk Vermont, a 501(c)(3) non-profit organization, is acting
only
as fiscal agent for the intensive)
Please print out this page and mail this form and your check to:
Kristina Bielenberg, PO Box 13, Montpelier, VT 05601.