Registration

*(denotes required field)

First Name:*

Last Name:*

E-Mail Address:*

E-Mail Address again:*

Please enter your E-mail Address a second time.

Which Course?:*

Permaculture Design Certification course Community Training in Ecological Design Mushroom Workshop Weekend

Postal Address:*

Postal Address2:

City/Post Office:*

Zip Code:*

Primary Phone Number:*

Date of Birth:*

Emergency Contact: Name and Relationship*

Emergency Contact: Phone Number*

Is there anything else we should know about you?

"I understand the basic risks of activities associated with workshops and will not hold the Finger Lakes Permaculture Institute or any of the individuals responsible for ANY decisions, actions, or accidents that result in damaged goods or persons.

I take full responsibility for safe travel to and from courses, for safe conduct in class and kitchen settings, and for safe interactions with my fellow students and instructors."

Please add your initials if you understand and agree with the above statement.*

How did you learn about the course?

Briefly describe how your family, work, educational and/or personal journey has brought you to be interested in this course.

This question is optional unless you are registering for the Permaculture Design Certification course.

What skills/qualities/knowledge would you like to acquire through this course?

This question is optional unless you are registering for the Permaculture Design Certification course.

Do you have any health problems special needs we should be aware of?

This question is optional unless you are registering for the Permaculture Design Certification course.

CAPTCHA Code:*