Potomac Valley Audubon Society · Natural History Workshop: Birding 101

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 can opt to receive updates about 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
$90 - Member
$100 - General Public

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 educational programs:

Donation

$

Registrant #1

Contact Information provided above will be used to register.

Registering ONLY for others?

I am NOT registering for myself - ONLY for others

Registrant #1

Name of Registrant #1 *

First Name

Last Name

Address of Registrant #1 *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

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’s order restricts group sizes or issues a Stay at Home Order
Hazardous weather is in the forecast that would create unsafe road conditions or unsafe conditions for being outside.
A staff member has contracted COVID-19.

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 photograph/videotape? *

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

I do not agree to allow the use of photographic images of the registered individual(s).

Coronavirus/COVID-19 Information and Procedures

PVAS has developed policies and procedures for program operations based on CDC, state, and local health guidelines. COVID-19 is an extremely contagious virus that spreads easily through person-to-person contact. Federal and state authorities recommend physical distancing as a means to prevent the spread of the virus. 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.

SAFETY PROTOCOLS:

Require participants that are not vaccinated to wear a mask when entering the building and when in close proximity to others
Promote healthy hygiene practices
Intensify cleaning and disinfection of shared supplies
Promote physical distancing of at least 6 feet between staff and participants
Disinfect bathrooms after every use
Provide a program that is entirely outdoors

I agree to abide by the following procedures and policies established by PVAS:

#1 *

I understand that members of my household CANNOT attend if they or any individual in my household has been diagnosed with COVID- 19, has COVID-19 symptoms, or has had exposure in the last 14 days to COVID-19.

#2 *

I understand that any members of my household who have taken any fever reducing medications such acetaminophen or ibuprofen within the past 24 hours may not attend.

#3 *

I will alert PVAS if anyone in my household has symptoms of COVID-19, such as fever, shortness of breath or persistent dry cough, in the 72 hours prior to the start of the program or throughout the course of the program.

#4 *

I understand that the program may need to be cancelled on short notice due to government order, participant or staff illness, or other emergency.

#5 *

I understand that if I or others I register cannot attend for any of the reasons listed above, I will receive a full refund.

#6 *

I understand that PVAS will follow, to the best of its ability, the safety protocols enumerated above.

#7 *

I will alert PVAS if anyone in my household shows symptoms of COVID-19 or tests positive for COVID-19 within a 14-day period after the program ends.

#8 *

I understand that any participants that are not vaccinated are required to wear masks outside when social distancing cannot be maintained as well as when entering the building.

#9 *

I understand that if PVAS must shorten the program experience for any of the reasons listed above, I will receive a partial refund.

#10 *

I understand that if PVAS becomes aware of any other participants or staff participating in the program who contracted COVID-19 within a 14-day period after the program ends, I will be alerted.

Coronavirus/COVID-19 Warning & Disclaimer

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.

Electronic Signature *

Form is NOT Complete!

Please indicate how many people you would like to register.