Potomac Valley Audubon Society · May 17 Climate Watch Survey

Event Metadata (Hidden on form)

When creating the form, enter pertinent information here. It is used when confirmations are sent to the registrant.

Form Data (Visible)

The form that the user sees starts here.

Contact Information

Name *

First Name

Last Name

Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Email *

Verify Email *

Phone *

Membership

PVAS Members enjoy benefits such as activities and upcoming events, membership pricing on events, and the satisfaction of knowing their support makes our programs possible.

Are you a PVAS Member?

Yes

No

Thank you!

Joining PVAS is the best way to stay up-to-date on our activities and upcoming events, plus, your member dues support our programs and operations.

www.potomacaudubon.org/support/become-a-member/.

Registration

Please indicate how many people you would like to register.

Registration	Quantity
$- No Charge

Registrations on a single form are limited to a total of five (5).

Please reduce the number of Registrations above to five (5) or fewer before continuing.

Voluntary Donation

I would like to donate the following amount in support of PVAS nature preserves, educational programs, and conservation initiatives.

Donation

$

Registrant #1

First Registrant

I am registering myself. Use contact information above for Registrant #1.

NOT registering myself - input information for Registrant #1 below.

Name of Registrant #1 *

First Name

Last Name

Address of Registrant #1 *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Email of Registrant #1 *

Verify Email *

Phone of Registrant #1 *

Registrant #2

Name of Registrant #2 *

First Name

Last Name

Address of Registrant #2 *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Email of Registrant #2 *

Verify Email *

Phone of Registrant #2 *

Registrant #3

Name of Registrant #3 *

First Name

Last Name

Address of Registrant #3 *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Email of Registrant #3 *

Verify Email *

Phone of Registrant #3 *

Registrant #4

Name of Registrant #4 *

First Name

Last Name

Address of Registrant #4 *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Email of Registrant #4 *

Verify Email *

Phone of Registrant #4 *

Registrant #5

Name of Registrant #5 *

First Name

Last Name

Address of Registrant #5 *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Email of Registrant #5 *

Verify Email *

Phone of Registrant #5 *

Terms and Conditions

Equity, Diversity & Inclusion Policy

The Potomac Valley Audubon Society (PVAS) does not exclude, deny benefits to, or otherwise discriminate against any service recipient, applicant, program staff, or the public on the basis of race, color, religion, national or ethnic origin, disability, age, sex, gender identity and expression, sexual orientation, political affiliation, or veteran status.

Cancellation Policy

PVAS will cancel a program if:

West Virginia Governor issues a Stay at Home Order or an order restricting group size
Hazardous weather is in the forecast that would create unsafe road conditions or unsafe conditions for being outside.
A staff member critical to an event is diagnosed with an active case of COVID-19.
The session doesn’t meet PVAS's registration number minimum.

If PVAS cancels this program and a registration fee has been paid, 100% of your payment will be refunded.

Registrants will be notified by email of any cancelations by 5:00 p.m. the evening before the program.

Registrants can cancel up to one week before the start this program and, if a registration has been paid, receive a refund of the registration fee less a non-refundable processing fee of $5. Please contact us if this poses a hardship.

*We understand that last minute cancellations might need to happen, but please try to let us know as soon as possible, so that depending on the circumstance, we can open the spot to someone else.

Terms and Conditions Acceptance *

I agree to all of the Terms and Conditions listed above.

Permission to Photo/Video *

Indicate whether you agree to allow PVAS to take and utilize photographic images of the registered individual(s) for the purpose of promotion and publicizing our programs and events.

I agree to use of image.

I do NOT agree to use of image.

Coronavirus/COVID-19 Warning & Disclaimer

PVAS has developed COVID-19 Policies and procedures for program operations based on CDC, state, and local health guidelines. Please review these before agreeing to accept and abide by them at the event you are registering for.

COVID-19 can lead to severe illness, personal injury, permanent disability, and death. Participating in our programs could increase the risk of contracting COVID-19. PVAS in no way warrants that COVID-19 infection will not occur through participation in our programs or accessing PVAS facilities.

COVID Release Acceptance *

I understand the above and assume said risks associated with COVID-19 on behalf of all those I am registering. I have read the PVAS COVID-19 policies and agree that all people I register will understand and agree to abide by these policies.

Electronic Signature *

Form is NOT Complete!

Please indicate how many people you would like to register.

Heads Up

Upon completion of this form, you will automatically be subscribed to our e-newsletter: Heads Up, PVAS! This newsletter goes out on the first and third Wednesday of every month. Please check your 'Spam' folder, or 'Promotions' tab if the newsletter cannot be found in your inbox.

Once you've received your first Heads Up, you can easily unsubscribe at anytime using the prompt at the bottom of the email. Please be assured that PVAS will not share your email address for any reason.