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WEST VIRGINIA WILDERNESS WORKSHOP 2007
REGISTRATION FORM

Please fill out this form and submit it to confirm your registration. Please send your $15 conference fee (to help cover food and lodging), and an additional $15 if attending the first aid training (Sierra Club members will be reimbursed), along with your registration form, to:

West Virginia Wilderness Coalition 
PO BOX 569
Morgantown , WV 26507  
(please make your check out to West Virginia Highlands Conservancy)

Please do not let the fees stop you from participating.  Arrangements can be made if  this fee would be a hardship.  The deadline for registration is June 22, 2007 .   To register after this deadline, you'll need to call Dave at 304-284-9548

Thank You!

PERSONAL INFORMATION

Name:

Address:    

Phone     Email:      

What organization (s) are you affiliated with?       


Are you a vegetarian or do you have any other special dietary needs?      

In case of emergency please contact

Name       phone number      
relationship      

Check One:  I�LL CAMP             I PREFER INDOOR LODGING

Please Check all meals you will eat during the workshop (we need a count before the event)
Friday June 29th                Saturday June 30th:            Sunday July 1st:
Dinner                             Breakfast                     breakfast
                                            Lunch                             Lunch
                                            Dinner

Sierra Club Outings Training:
I'd like to participate in the Sierra Club Outings Training
(Sunday, July 1, 9:30 a.m. - 2:30 p.m.)

I'd like to participate in the associated First Aid course
(Saturday, June 30, 1-5 p.m. Know that this course runs concurrently with advocacy training sessions.)

The following is just to get an assessment of participants� level of knowledge and experience

Have you seen the West Virginia Wilderness slide show?      

Have you worked on West Virginia Wilderness issues before?      

If so, how long, and in what capacity have you worked on this issue?

Registration Confirmation

By digitally signing this form and submitting it, you pledge to attend the West Virginia Wilderness Workshop at the Mountain Institute, June 29-July 1, 2007 unless a personal or family emergency should arise.  Please realize that a spot will be reserved for you and meals and lodging paid for in advance.  If a situation arises and you need to cancel your registration, please notify us as soon as possible. By typing your name in the signature box below, you are stating that you agree to the registration confirmation statement

Signature          Date

  Questions? Contact Dave Saville 304-284-9548 or [email protected]